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Biomedical subjects

H Fernandez

Publications and source records attributed to H Fernandez.

At least 307 records · Page 17Linked to original sources
PubMedDate not supplied

Suspected postpartum endometritis: a controlled clinical trial of single-agent antibiotic therapy with Amox-CA (Augmentin) vs. ampicillin-metronidazole +/- aminoglycoside.

Endometritis is the commonest postpartum complication and is one of the leading causes of maternal morbidity, if not mortality. The object of the present clinical trial was to assess the efficiency of single-agent therapy with Amox-CA (Augmentin) (formulation which includes a beta-lactamase inhibitor), against standard treatment which necessarily combines two or three antibiotics depending on the clinical severity of the case. 101 patients were evaluated in this comparative prospective randomized study. The mild forms were defined by a temperature between 37.9 and 38.4 degrees C and the severe forms by a temperature of more than 38.5 degrees C (which alone required treatment with three antibiotics). The time until the return of apyrexia and the clinical cure rate, as well as duration of treatment, were identical in both groups. Tolerance was good: no side effect requiring discontinuation of treatment occurred. In the population value, the use of a single-agent therapy with amoxycillin/clavulanic acid is not significantly different from a double or triple-agent regimen, and the convenience is increase.

Adult↗
PubMedDate not supplied

Intraperitoneal local anaesthetic for shoulder pain after day-case laparoscopy.

Laparoscopy is frequently associated with postoperative shoulder pain that may last several days. We have assessed the analgesic effect of intraperitoneal local anaesthetics during day-case diagnostic laparoscopy. 80 young women were randomly assigned to one of four groups of 20 patients each: group 1, no peritoneal administration; group 2, 80 ml saline injected under direct vision in the right subdiaphragmatic area at the start of the procedure; group 3, 80 ml 0.5% lignocaine with adrenaline (320,000 dilution); group 4, 0.125% bupivacaine with adrenaline (800,000 dilution). Scapular pain was assessed with a visual analogue pain scale, and information about nausea, vomiting, abdominal pain, and analgesic requirements during the first 48 h was sought. Both local anaesthetics were more effective in reducing postoperative shoulder pain than either control or saline. Analgesic requirements were greater in the non-treatment groups than in the local anaesthetic groups. Intraperitoneal local anaesthetic administration during laparoscopy is both a non-invasive and an efficient method of reducing the intensity of scapular pain.

Adult↗
PubMedDate not supplied

Fetal-maternal hydrops syndrome in human parvovirus infection.

A case of maternal generalized edema with hyponatremia, hypoosmolality and secondary hyperaldosteronism was associated with pseudomolar plasma human chorionic gonadotropin (hCG) concentrations in a case of fetal and placental hydrops due to parvovirus B19 infection. Digoxigenin in situ hybridization techniques were effective in demonstrating parvovirus B19 infection on fixed tissues. Hydropic changes in the placenta may have massively increased the maternal plasma hCG concentration with subsequent fluid imbalance leading to maternal hydrops mimicking molar pregnancy.

Chorionic Gonadotropin↗
PubMedDate not supplied

Effect of betamethasone on the fetal heart rate pattern assessed by computerized cardiotocography in normal twin pregnancies.

The effects of corticosteroids, given for enhancement of fetal lung maturation, on fetal heart rate (FHR) are controversial and may decrease its variability. FHR patterns were analyzed by computerized cardiotocography in 46 fetuses from 23 normal dichorionic twin pregnancies on days 0, 1 and 4-7 while the mothers received four intramuscular injections of 3 mg betamethasone sodium and 3 mg betamethasone acetate within 48 h to enhance fetal lung maturation. Compared with pretreatment values, FHR showed a decrease in long- and short-term variations; other parameters, e.g. the number of fetal movements, remained unchanged. However, decreased FHR variation was followed by an increase in the acceleration rate after maternal administration of betamethasone. These modifications were transient and should not lead to unnecessary anxiety or intervention in otherwise normal fetuses.

Betamethasone↗
PubMedDate not supplied

Modeling skill utilization among prehospital care personnel.

Several models linking skill utilization rates for advanced aids and drugs used in prehospital patient management with indicators of the structural and operational characteristics of emergency providers were derived from empirical data. Because the utilization patterns for each clinical category were taken into account, different models were built for each of these categories.

Allied Health Personnel↗
PubMedDate not supplied

Chicken as potential contamination source of Campylobacter lari in Iquitos, Peru.

In order to know the importance of chicken as natural reservoir of Campylobacter lari in Iquitos, Peru; samples were obtained by cloacal swabs from 200 chickens and immediately placed into a semisolid enrichment medium; these were streaked on modified Skirrow Agar. The organism was isolated from 21 (10.5%) samples, corresponding 58.8% to biovar I and 41.2% to biovar II (Lior scheme). The results provide evidence that chicken appear to be prominent reservoirs of Campylobacter lari in Iquitos.

Animals↗
PubMedDate not supplied

[Hereditary hypertension in Recklinghausen's disease during pregnancy. A family].

We report the case of a pregnant woman who presented with neurofibromatosis and hypertension the latter revealed by abruptio placentae. Severe hereditary hypertension was noted in the family during pregnancies that were sometimes complicated by intrauterine growth retardation, abruptio placentae and intrauterine foetal death. Thus, neurofibromatosis in a pregnant woman has a poor obstetrical outcome when it is associated with a personal or family history of hypertension. Such women must be treated with extreme care and hospitalized at the end of the third trimester. The advisability of prevention with low-dose aspirin during the first trimester is discussed.

Female↗
PubMedDate not supplied

[Pharmacokinetics of methotrexate and clinical response associated in the medical treatment of ectopic pregnancies].

Methotrexate (MTX) is used in the medical treatment of unruptured ectopic pregnancy. This drug is administered by intramuscular (IM) or intrasaccular (IS) injection under sonographic control. No data are available concerning the pharmacokinetics of MTX in this new indication. This study compares the two administration routes in 12 patients (21 to 37 years) taken as their own control and presenting with ectopic pregnancy (51 +/- 12 days of amenorrhea). Our aim was to compare the pharmacokinetic profile of MTX for each route to facilitate its use in the future. The initial level of hCG was 4.474 +/- 4.184 mIU/ml. Each patient firstly received 1 mg/kg of MTX intrasaccularly under vaginal sonography. The same dose was injected intramuscularly 48 hours later. The pharmacokinetic profiles of MTX after IS and IM administrations were determined after both injections during 48 hours. MTX serum levels were measured by Fluorescence Polarization Immuno Assay. Data were analyzed by model independent methods and compared by a Wilcoxon T test (p 0.01 was considered as significant). All the unruptured ectopic pregnancy were cured and the hCG serum levels were normalized (10 mIU/ml) in 37 +/- 18 days. After IM administration, AUC0-infinity is significantly (p 0.01) increased i.e., 15.1 +/- 4.1 mumol.h/l versus 11.2 +/- 4.8 after IS injection. T1/2 lambda z and MRT remained unchanged whatever the route is i.e., 11.3 +/- 4.9 h and 8.6 +/- 3.9 h (IS) versus 12.1 +/- 5.9 h and 7.3 +/- 1.8 h (IM). The decrement of AUC0-infinity 8 determined after IS injection might be the consequence of the capture of the MTX by the trophoblastic cells (target cells).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[Identification of Streptococcus viridans in clinical specimens].

In a 4 year prospective study of "viridans" or non-groupable streptococci 100 clinically significant strains were isolated. Strains were defined as significant when found in two or more samples of blood cultures, or when seen on Gram staining together with inflammatory reaction. Fifty-two strains were speciated by 10 physiological characteristics. In 42 cases additional tests were performed. Only 16 isolates were unidentifiable by the techniques used. Sources of isolates included purulent lesions (53%) (mainly S. milleri and S. mitior); endocarditis (27%) (S. bovis I, S. sanguis, S. mutans, S. bovis II) and urinary tract infections (10%) (S. bovis II, S. milleri).

Endocarditis, Bacterial↗
PubMedDate not supplied

[Transplacental transport and feto-placental metabolism of drugs: study methods, therapeutic contributions and implications].

Pregnancy is a specific dynamic state and the potential usefulness of caring for a fetal and/or adjacent disorder by treating the mother is now well established. Pregnant women being excluded from the investigational field of clinical trials, only few studies exist concerning evaluation of the pregestational metabolism or transplacental transfer (TPT) of drugs. Questions are extensive and complex. Does TPT occur at a given gestational age (GA), in the context of a particular type of pathology, when a drug is administered by a certain dosage regimen? If this is the case, what is the rapidity of penetration of the products of conception by the drug (bearing in mind its physical-chemical characteristics)? Need harmful adverse effects on the child be feared? Is such penetration desirable, of no consequence or dangerous? Does the possibility exist of accumulation in the placenta, fetal tissue or amniotic fluid? Should such findings modify the therapeutic regimens of drugs given to expectant mothers? After dealing with the ethical and physiological context in which such research is undertaken, the authors review methods for the study of TPT developed both in vitro and in vivo. The current review covers the period between 1972 and 1993. Exchange mechanisms are complicated and models developed in vitro only partially reflect the actual equilibria which develop. These include: 1) the perfused cotyledon model, which while simple, elegant and inexpensive, offers only a localized and fixed view of pregnancy; 2) the necessary study, using microsomes, of placental metabolic capacity (enzyme cartography). In vivo study of TPT is based upon various multicompartmental pharmacokinetic models, some of which have been relatively validated in animals. The simplest indicator for the in vivo evaluation of TPT of a drug in the human species is determination of a feto-maternal blood concentrations ratio (usually performed at the time of separation). The usefulness and limitations of this parameter are controversial, and it would seem preferable to associate it with a kinetic profile of variations in blood concentrations established in the mother. Any extrapolation of a single result to fetal and adjacent tissues must be done with the greatest caution. Study of the TPT of therapeutically useful agents is essential to the understanding of their metabolism and is a prerequisite to the use of medications during pregnancy, bearing in mind that any such use must always be with the greatest care and with extremely well-founded indications.

Ethics, Medical↗
PubMedDate not supplied

[Experience of ectopic pregnancy].

This survey relates to the experience and the management of women who have received a treatment for an ectopic pregnancy. It is based on 31 clinical interviews, conducted a month after the end of surgical or medical treatment. Among these women, 42% had had previous treatment for sterility. The main results show that 16% had never previously heard of ectopic pregnancy, and 29% do not see any reason why they had had one. For the patients, the diagnosis had not been made early enough: 45% feel that the consequences could have been serious if they had not taken the matter seriously themselves. Women clearly express some strong feeling against the health professionals (74%) who were responsible for their medical care, in spite of the attention they received, which reveals the psychological trauma they suffered. Although 55% of women felt depressed, for some of them the ectopic pregnancy seemed to operate as an exorcism from a previous more serious situation. They place their hope in a future pregnancy under close medical supervision. When it appears necessary, psychological support should be offered to these patients.

Adaptation, Psychological↗