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Biomedical subjects

A Trilla

Publications and source records attributed to A Trilla.

At least 91 records · Page 5Linked to original sources
PubMed1988

Characteristics of tuberculosis in HIV-infected patients: a case-control study.

To test the hypothesis that HIV infection can modify the clinical characteristics of tuberculosis, 65 consecutive cases of tuberculosis in HIV-seropositive patients diagnosed in Barcelona (Spain) were compared with 65 HIV-seronegative controls matched for age and sex. Thirty of the 65 cases were accepted as AIDS cases (August 1987 Centers for Disease Control criteria) only because of the tuberculosis. Among the cases 54 (83%) were parenteral drug addicts and 88% were males. The tuberculosis was pulmonary or pleural in 62 controls (96%) but in only 25 cases (39%; P less than 0.0001). Lymph nodes were involved in 25 cases (39%) and in none of the controls (P less than 0.0001). Disseminated forms of tuberculosis were present in seven cases (11%) and in no controls (P less than 0.007). Bone, joints and central nervous system involvement were also significantly (P less than 0.05) more frequent in cases. The treatment (isoniazid and rifampin for 6 months plus ethambutol and pyrazinamide during the first 2 months) was always effective. One relapse was detected after a median follow-up of 55 months in cases and none in controls after a median follow-up of 43 months. Twenty-five cases (39%) and 14 controls (22%) developed mild or severe side effects related to the treatment (P less than 0.004). In conclusion, most of the HIV-infected patients with tuberculosis were drug addicts with extrapulmonary or disseminated forms. A short course of treatment (6 or 9 months) may be enough but side effects were frequent.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Vertebral arch tuberculosis in two human immunodeficiency virus-seropositive heroin addicts.

We studied two cases of disseminated tuberculosis with vertebral arch involvement in drug addicts seropositive for human immunodeficiency virus. The first patient developed a paraplegia while he was recovering from a meningeal tuberculosis. On the abdominal plain roentgenogram, the right transverse process of L-2 was absent, and a computed tomographic scan revealed destruction of the right vertebral arch together with a collection in the paravertebral area. The second patient had miliary tuberculosis and complained of lumbar pain. The radiologic findings were similar to those in the first case, but at the L-4 level.

Adult↗
PubMed1987

Henoch-Schönlein purpura complicating staphylococcal endocarditis in a heroin addict.

A 21-year-old heroin addict with right-sided staphylococcal endocarditis developed skin purpura, abdominal pain, bloody diarrhea, proteinuria and microscopic hematuria. Skin biopsy showed leukocytoclastic vasculitis with IgA deposits in dermal vessels and renal biopsy disclosed proliferative glomerulonephritis with granular mesangial IgA and fibrinogen deposition. These features are typical of Henoch-Schönlein purpura. Symptoms abated spontaneously. Since the syndrome appeared during cloxacillin therapy, both this drug or the infectious disease itself could have triggered the immune response. Henoch-Schönlein purpura is a distinct clinical entity that can complicate the course of staphylococcal endocarditis.

Adult↗
PubMed1986

Lymphocyte subpopulations in Spanish parenteral drug addicts.

Lymphocyte subpopulations were studied in 29 symptom-free Spanish prisoners who were active parenteral drug abusers. In 16/29 drug addicts (55%) the helper-inducer/suppressor-cytotoxic ratio (Leu 3a/Leu 2a) was less than 1. None of these 16 patients had lymphopenia and only 2 had a reduction in the number of Leu 3a cells. In drug addicts the number of lymphocytes (p less than 0.01) and the number and percentage of Leu 2a cells (p less than 0.001) were significantly raised. The addicts also had a higher absolute number of T cells when measured by their ability to react with the Leu 4 antibody (p less than 0.01). However, the E-rosette forming cells were significantly reduced. Thus the E-rosette test may lead to an overestimation of "null" cells. Furthermore drug addicts had a higher percentage (p less than 0.001) of Leu 7 positive cells (NK and K cells), but a normal percentage of B and phagocytic cells. Five drug addicts had generalized persistent lymphadenopathies, and 2 had skin anergy. We believe that most of the immunologic abnormalities seen in these apparently healthy drug abusers can be explained by an antigenic overload.

Adolescent↗
PubMed1984

Pseudoprimary aldosteronism from the topical application of 9-alpha-fluorprednisolone to the skin.

A 56 year old man presented with hypertension, hypokalemia and depressed plasma renin activity. Plasma aldosterone was normal, but was considered inappropriate in the presence of hypokalemia. An adrenal scan showed unilateral uptake of 131I-cholesterol and a presumptive diagnosis of adrenal adenoma was made. At surgery, no adenoma was found. Instead, the adrenal was atrophic, and in this case also contained caseating granulomas. Postoperative plasma aldosterone values were consistently normal and adrenocortical insufficiency was ruled out. On requestioning, the patient admitted long-term topical use of a skin cream containing 9-alpha-fluorprednisolone. Withdrawal of the fluorprednisolone cream led to normalization of blood pressure and serum potassium, and on renewed contact with the drug, hypertension and hypokalemia reappeared. The patient is now normotensive and normokalemic after permanent discontinuation of the cream. Topical cutaneous application of 9-alpha-fluorprednisolone can induce a syndrome closely mimicking primary aldosteronism. A high degree of suspicion and adequate history taking are critical for the appropriate management of such patients and the avoidance of unnecessary or dangerous procedures.

Administration, Topical↗
PubMedDate not supplied

In vitro activity of three carbapenem antibiotics. Comparative studies with biapenem (L-627), imipenem, and meropenem against aerobic pathogens isolated worldwide.

The in vitro activity of biapenem (formerly L-627 or LJC10, 627), a new carbapenem, was compared with that of imipenem and meropenem against > 6000 clinically significant pathogens isolated in six countries worldwide. Biapenem was active against members of the family Enterobacteriaceae with a 90% minimum inhibitory concentration (MIC90) ranging from < or = 0.06 to 2 micrograms/ml. Only Serratia spp. and Providencia spp. were less susceptible (MIC90, 8 micrograms/ml). Pseudomonas aeruginosa and Xanthomonas maltophilia displayed an MIC90 of > or = 8 micrograms/ml biapenem/ml whereas Acinetobacter spp. were susceptible at < or = 1 micrograms/ml. Oxacillin-resistant staphylococci were resistant to biapenem at > 8 micrograms/ml whereas oxacillin-sensitive staphylococci were susceptible at < or = 1 micrograms/ml. Biapenem, imipenem, and meropenem displayed poor activity against Ent. faecium (MIC90, > or = 8 micrograms/ml), and only imipenem displayed slightly better activity against Ent. faecalis (MIC90, 4 micrograms/ml). The rank order of activity against groups of isolates was Enterobacteriaceae (meropenem > biapenem > or = imipenem), Ps. aeruginosa (biapenem = meropenem = imipenem), oxacillin-sensitive staphylococci (imipenem > or = biapenem = meropenem), oxacillin-resistant staphylococci (biapenem = meropenem = imipenem), and Enterococcus spp. (biapenem = meropenem = imipenem). These in vitro suggest that further developmental work on biapenem is warranted.

Enterobacteriaceae↗
PubMedDate not supplied

[Is there a place for otorhinolaryngology in primary care? Analysis of different areas].

Otolaryngological disorders do have a high incidence, and prevalence and require specific physical examinations amongst general population. As a result, it is believed that it would be efficient to have otorhinolaryngologists within the primary care system. The main aim of this study was to assess the differences in hospital referrals comparing primary care units with and without ENT specialists. The study was carried out in Osona County (Catalonia, Spain). We studied the referrals to the hospital from two different primary care units, one with otorhinolaryngology services and the other without them. We analysed the morbidity, follow up and demographic variables of first visits in the hospital ENT department referred by these two primary care units. The primary care organisation without ENT specialist tends to refer more patients (3.96 first visits more per 1000 inhabitants a year, CI 95% 2.84-5.09) with ENT problems than the primary care one with ENT specialist. The difference is mainly due to an higher number of referrals that do not require hospital treatment (i.e. acute otitis, patients without an ENT clear diagnosis). In the area with ENT specialist, GP's also tend to refer patients directly to the hospital, hampering the organisation efficiency. The referrral pattern of GPs from the two organisations is quite similar, and they refer a high percentage of patients that do not need ENT hospital care. The study shows that ENT specialists in primary care units refer less patients with ENT disorders that can be successfully diagnosed and treated outside the hospital.

Adolescent↗
PubMedDate not supplied

[Analysis and classification of hospital emergencies through Ambulatory Patient Groups].

AIM: To assess the feasibility and results of application of Ambulatory Patient Groups (APG) patient's classification system to the case-mix of patients seen at the Emergency Departments (ED) of 6 Barcelona metropolitan area hospitals. METHODS: Development of a minimum discharge data set specific for the Emergency Departments (CMBDAU). Gathering of relevant variables from a random sample of patients seen at the ED using the ED discharge reports. Use of the APG classification system to those episodes. RESULTS: A total of 11.188 episodes were codified and grouped with the APG system. Fifteen diagnostics identified 25% of all episodes. Nearly 50% of all procedures performed at the ED were common and simple procedures. Fifteen APG's grouped 50% of all cases seen at the ED. CONCLUSIONS: The ED Uniform Discharge Data Set (CMBDAU) developed is a valid instrument for describing the case-mix seen at the ED, and its grouping by means of the APG system provides consistent and meaningful results. The widespread use of systems like APG in the ED requires a former validation of relative weights assigned in the US system. The availability of human and technical resources must also be assessed, in order to guarantee the quality and sustainability of such a system.

Adolescent↗
PubMedDate not supplied

Nosocomial bacteremia in a large Spanish teaching hospital: analysis of factors influencing prognosis.

Five hundred forty-three episodes of nosocomial bacteremia were prospectively followed in a large Spanish university hospital. The commonest isolates were Staphylococcus epidermidis, Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, and Candida species. The most frequent sources of infection were intravenous lines, urinary tract, and lower respiratory tract. Overall mortality was 18%. A step-forward logistic regression analysis defined eight variables independently influencing the outcome: shock, underlying rapidly fatal disease, high-risk source of bacteremia (intraabdominal, lower respiratory tract, or not identified), age more than 70 years, hospitalization in intensive care or medical units, inappropriate antibiotic treatment, infection due to a high-risk microorganism (P. aeruginosa, Serratia marcescens, Klebsiella, Bacteroides, or Candida), and development of septic metastasis. The identification of those factors independently influencing the outcome and their possible modification may represent a further step in the control of nosocomial bacteremia by improving its prognosis.

Adult↗