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Alvaro Sanabria

Publications and source records attributed to Alvaro Sanabria.

10 recordsLinked to original sources
PubMed2006

Prophylactic antibiotics in chest trauma: a meta-analysis of high-quality studies.

BACKGROUND: Use of antibiotics in patients with isolated chest trauma is controversial. Available studies offer contradictory results because of small sample sizes. However, information provided by recent randomized controlled trials (RCT) included in a systematic review and meta-analysis could help solve the controversy. We performed a systematic review using high-quality information related to the use of antibiotics in patients with a chest tube. METHODS: We developed a systematic review to evaluate the effectiveness of prophylactic antibiotics in chest-trauma patients. Studies included were class I RCT comparing prophylactic antibiotics versus placebo in patients with isolated chest trauma. Main outcomes were posttraumatic empyema and pneumonia. RESULTS: Five Class I studies were selected. There were statistically significant differences regarding the frequency of posttraumatic empyema (RR 0.19) and pneumonia (RR 0.44) in favor of the use of prophylactic antibiotics when compared with placebo. CONCLUSIONS: The use of prophylactic antibiotics in patients with chest trauma decreases the incidence of posttraumatic empyema and pneumonia.

Anti-Bacterial Agents↗
PubMed2006

Decision-making analysis for selection of antibiotic treatment in intra-abdominal infection using preference measurements.

BACKGROUND: Antimicrobial therapy of abdominal infections is important to the prognosis of affected patients. The choice of antimicrobial therapy must consider effectiveness, safety, cost, and antibiotic resistance, among numerous factors. However, in reality, decisions are made assuming bioequivalence between regimens, without considering the specific attributes of any particular regimen. The objective was to determine the best antibiotic regimen for patients with community-acquired abdominal infection on the basis of a decision analysis that included effectiveness as well as safety, measured as adverse effects. METHODS: A decision tree was built using information from a systematic review of the literature on the effectiveness of antimicrobial regimens tested in randomized clinical trials (RCTs) and the frequency and severity of adverse effects. The quality of the articles was assessed with the Oxford criteria for RCTs. The main outcome was preferences reported by surgeons, measured on a numeric scale. Preferences were obtained using a standard survey that reported each adverse effect with its respective intensity, reversibility, sequelae, duration of symptoms, and necessity for change of antibiotic. Each of the surgeons had to assign a value blindly from 0 to 10, where 10 was the most severe. A sensitivity analysis was conducted varying the frequency of adverse effects. RESULTS: The regimens analyzed were amikacin-metronidazole, amikacin-clindamycin, ciprofloxacin-metronidazole, ampicillin-sulbactam, ceftriaxone-metronidazole, piperacillin-tazobactam, and ertapenem. The perceived severity of adverse effects reported were: Acute neuromuscular blockade (8.0), severe allergic reaction (7.5), ototoxicity (7.4), nephrotoxicity (7.1), antibiotic-associated colitis (7.0), peripheral neuropathy (5.3), general neurological symptoms (4.9), gastrointestinal symptoms (3.1), and other general symptoms (2.6). Favored regimens were ceftriaxone-metronidazole (1.15), ampicillin-sulbactam (1.24), piperacillin-tazobactam (1.27) and ertapenem (1.28). These strategies dominated the other therapeutic schemes. Sensitivity analysis showed no changes in the dominance reported when the frequency of adverse effects was maintained in the known clinical range. CONCLUSIONS: Antibiotic regimens that contain aminoglycosides are not bioequivalent to those without aminoglycosides when effectiveness and adverse effects are considered simultaneously. Antibiotic regimens that do not use aminoglycosides must be the first line of treatment for abdominal sepsis acquired in the community.

Abdominal Abscess↗
PubMed2006

[Ultrasonographic estimation of the normal volume of the thyroid gland in pediatric populations].

INTRODUCTION: The World Health Organization bases its reference standards for normal thyroid volume on values derived from measurements of European children. However, WHO recommends that normal values for each region be estimated separately, given the variability as a consequence of geographic, racial, and nutritional differences. OBJECTIVE: A normal standard of thyroid volume was estimated for the pediatric population of Bogotá, Colombia. MATERIALS AND METHODS: A cross-sectional study was carried-out in 591 children assessed at the Clínica Jorge Bejarano, Bogotá, Colombia, between January and August 2003. Children with maternal or personal history of thyroid disease and those with abnormal weight or height characteristics were excluded. Age, weight, and body surface index were recorded for each child. Thyroid volume was estimated by ultrasonography using the ellipse formula. RESULTS: The mean estimated volume for each age group was as follows: 0.6 +/- 0.2 cm3 for neonates, 1.1 +/- 0.6 cubic centimeters for milk-fed babies, 2.2 +/- 1.3 cc for pre-school age children, 3.0 +/- 1.7 cc for school age children and 5.7 +/- 3.1 cc for adolescents. Thyroid volume increases with increasing body surface. A linear relationship between the natural logarithm of the thyroid volume and the square root of the body surface was found. CONCLUSIONS: The normal thyroid volume for Bogotá children was smaller than the World Health Organization reference value. Values described in the current study are recommended for local use as the normal parameter.

Adolescent↗
PubMed2003

Routine chest roentgenogram after central venous catheter insertion is not always necessary.

BACKGROUND: To evaluate the usefulness of routine radiologic control after the insertion of a central venous catheter as a tool that might modify treatment of patients. METHODS: A prospective study was made of 149 patients submitted to central venous catheter insertion. RESULTS: In 55% of the patients the roentgenogram showed an adequate placement of the catheter tip and in 3.6% it showed some abnormal finding. Ten modifications were carried out based on the radiologic results. The prolonged partial thromboplastin time value and the subjective degree of difficulty showed a statistical relation to the appearance of complications. The number of punctures above one related to abnormal radiologic findings. CONCLUSIONS: The results suggest that routine chest radiology after the insertion of a central venous catheter is not always necessary and that it should be ordered selectively, according to the findings made during the procedure and the subjective degree of difficulty.

Adolescent↗
PubMed2002

Penetrating neck injuries: helical CT angiography for initial evaluation.

PURPOSE: To report an experience with helical computed tomographic (CT) angiography as the initial procedure to rule out arterial lesions caused by penetrating neck injuries. MATERIALS AND METHODS: During 27 months, 175 patients were referred for helical CT angiography of the neck because of clinical suspicion of arterial injuries. The protocol included a 100-mL bolus of nonionic contrast material injected at 4.5 mL/sec, with 11-second scanning delay, 3-mm collimation, and pitch of 1.3-2.0. CT images were interpreted prospectively by the emergency radiologist, and two radiologists retrospectively interpreted studies with consensus. Outcome was determined with examination of patients and their charts. The sensitivity, specificity, and positive and negative predictive values were calculated. RESULTS: Studies in two patients were considered inadequate for diagnosis; these patients were referred for conventional arteriography and had normal findings. In 27 patients (15.6%), arterial lesions were detected. One patient had two arterial injuries. Lesions demonstrated with helical CT angiography were arterial occlusion (n = 14), pseudoaneurysm (n = 8), pseudoaneurysm and arteriovenous fistulae (n = 4), and partial thrombosis (n = 2). The remaining 146 patients had normal arteries. On the basis of these findings, patients were treated with surgery (n = 21), endovascular intervention (n = 7), and observation alone (n = 146). CONCLUSION: Results indicate that helical CT angiography can be used as the initial method for evaluation in patients with possible arterial injuries of the neck.

Adolescent↗