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Biomedical subjects

H Gil

Publications and source records attributed to H Gil.

At least 19 recordsLinked to original sources
PubMed2002

The impact of resistance to methicillin in Staphylococcus aureus bacteremia on mortality.

Background: It is unclear whether methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive S. aureus (MSSA) differ in virulence. We therefore carried out a prospective study of cases of S. aureus bacteremia over a period of 2 years at our university hospital. We report herein the results of a comparative analysis of the clinical characteristics and mortality rates associated with cases of bacteremia caused by MRSA and MSSA. Methods: Over a 2-year period, we reviewed the medical records of hospitalized patients with blood cultures positive for S. aureus. Demographic characteristics, underlying diseases, diagnosis, clinical features, severity, laboratory findings, antimicrobial treatment, and resistance to methicillin were analyzed as possible risk factors for death attributed to bacteremia. Results: The rate of mortality attributed to bacteremia was 27.3% (27 patients): 13 (43.3%) deaths were recorded for patients infected with MRSA and 14 (20.3%) for patients infected with MSSA (P=0.0339, OR=3.00 (1.08--8.46)). Two variables were significantly associated with death within 14 days of the onset of bacteremia in univariate and multivariate analyses after adjusting for antimicrobial treatment: malignant hematologic disease (protective factor; OR=0.184 (0.038--0.882)) and resistance to methicillin (risk factor; OR=2.97 (1.12--7.88)). Conclusion: This study shows that S. aureus bacteremia has a high mortality rate, especially if the strain involved is methicillin-resistant, regardless of patient age and the efficacy of antimicrobial treatment.

Journal Article↗
PubMed2001

[Myelodysplasias and systemic diseases. A non-fortuitous association].

PURPOSE: Myelodysplastic syndromes are clonal hematologic disorders, expanded from myeloid stem cells. A primitive immunologic disorder is discussed. This hypothesis could explain a non-casual association with systemic diseases. The aim of our study is to test this hypothesis. METHODS: We retrospectively investigated the data of 60 patients with myelodysplastic syndromes (group I) hospitalized in our unit from 1990 to 1999. The frequency of systemic disorders was screened and compared to controls (group II). Group II consisted of 120 patients matched for age and sex and hospitalized in the same hospital during the same period. RESULTS: Sixty patients were included (mean age: 83 years old). Myelodysplastic syndrome subtypes were refractory anemia with excessive blasts (52%), refractory anemia (43%) and sideroblastic anemia (5%). Fourteen cases of systemic manifestations were reported in group I (23%) and five in the controls (4%) (P < 0.0001). Systemic manifestations in group I included vasculitis in six cases (42%), polyarthritis in three cases (21%), systemic amyloidosis AA in two cases (14%), relapsing polychondritis in one case, pyoderma gangrenosum in one case and celiac disease associated with a systemic granulomatosis in one case. In the controls, vasculitis was present in four cases and polyarthritis in one. Median age at onset of myelodysplastic syndrome was not influenced by the association with systemic disorders which, in return, have not influenced the myelodysplastic syndromes' subtypes. Myelodysplastic syndromes succeeded to systemic manifestations in 71.4% of cases and could not be attributed to immunosuppressive therapy. CONCLUSIONS: The association of myelodysplastic syndromes with systemic manifestations seems not to be casual. It raises the hypothesis of a primitive immunological disorder in both diseases. Moreover, the description of two cases of systemic amyloidosis and one case of pyoderma gangrenosum might suggest an additional disorder of macrophages or granular cells.

Age of Onset↗
PubMed2001

Presence of granulocytic ehrlichia in ticks and serological evidence of human infection in La Rioja, Spain.

In order to estimate the risks of human granulocytic ehrlichiosis (HGE) in an endemic area for Lyme disease in the North of Spain (La Rioja), we collected and investigated by PCR specific to the E. phagocytophila group DNA, a total of 6870 Ixodes ricinus ticks. We also used an indirect immunofluorescence (IFI) test to study the presence of antibodies to the HGE agent in 147 human serum samples including patients with Lyme disease (LD), forestry workers, and persons with history of previous tick bite. Fifty serum samples from healthy people resident in urban areas and with no history of tick-bite disorder and without tick exposure were used as controls. Four of 76 adults and 49 of 203 nymphs pools carried E. phagocytophila DNA. This result, and the finding of 1.4% of sera reacting in the IFI test confirms that this tick-borne agent is present in La Rioja, and that humans show evidence of contact with it. HGE should be considered in the differential diagnosis of flu-like syndromes in the study area in the north of Spain.

Animals↗
PubMed2000

[Wegener's disease and central diabetes insipidus].

Vasculitis with central diabetes insipidus is a rare condition which must be recognized for proper management. We report a case of Wegener's granulomatosis with diabetes insipidus and review the literature concerning the clinical and radiological features of this association. We examined the data supporting the efficacy of cyclophosphamide in diabetes insipidus. Diabetes insipidus is inaugural in 46% of cases. Wegener's granulomatosis has no distinctive features when associated with diabetes insipidus. MR imaging reveals an enlargement of the posterior pituitary in 100% of cases. Cyclophosphamide is effective in 80% of cases. In Wegener's granulomatosis, pituitary vasculitis is a rare condition. MR imaging is the most accurate method for pituitary exploration. Cyclophosphamide is effective in the treatment of vasculitis lesions in Wegener's granulomatosis.

Aged↗
PubMed1999

[Withdrawing corticosteroid therapy: the stress of the last milligrams...].

Suppression of the hypothalamo-pituitary-adrenal axis (HPA) is a classic complication of corticosteroid therapy. There is some controversy over the conditions necessary to recover normal HPA activity. Most agree that the total duration of treatment, the maximal dose, the total cumulative dose and the the rate of withdrawal are all important factors in predicting HPA suppression. Recent studies provide evidence contradicting this opinion. It is now demonstrated that HPA activity is completely recovered as soon as the prednisone dose falls below 5 mg per day, that adrenal function is totally blocked for doses above 7.5 mg per day, and that an intermediary response to synactene is obtained for daily doses of 7.5 to 5 mg. It is thus reasonable to conclude that corticosteroid therapy can be safely withdrawn when the daily dose is less than 5 mg and, if a higher dose is given, a temporary increment would be indicated in case of stress.

Adrenal Cortex Hormones↗
PubMed1999

[Treatment of recurrent ulceration with low doses of thalidomide. Pilot study in 17 patients].

PURPOSE: Though thalidomide in a dosage of 100 mg/day is the standard treatment for recurrent oral and genital ulcers (OGU), its toxicity would be less important with lower dosage, while its efficacy would be identical. Furthermore, duration of treatment might be a major risk factor for the development of subsequent polyneuropathy. To determine the dosage of thalidomide leading to the best efficacy/toxicity ratio, a pilot study was conducted from 1993 to 1996. METHODS: Seventeen patients with OGU (mean age: 43 years, sex-ratio: 12:5) were included in the study and presented either recurrent oral ulcerations (8 patients), oro-genital ulcerations (3 patients), Behçet disease (4 patients), or recurrent OGU associated with leukemia (2 patients). The initial dosage of thalidomide was 50 mg/day (1 tablet) for 1 month. If the patient's condition improved, the dosage was reduced to one tablet every other day for 1 month and one tablet every 3 days thereafter. Nerve conduction studies (EMG) were performed at inclusion in the study and every 6 months thereafter. RESULTS: Among the 17 patients, remission was observed in ten patients within the first month of treatment and the condition of seven patients improved. Complete remission was observed in six patients after a 2-month treatment and in one patient after 4 months. A 200-mg/8 days dosage induced prolonged remission in 12 patients. Among them, ten patients received a 150-mg dosage over 8 days thereafter and disease relapsed in four of them. Among the six patients who received a 100-mg dosage over 8 days, only one relapse was observed. EMG showed a decrease in sensory nerve action potentials in six patients after 8 months and a half on average. Only three patients had to discontinue their treatment due to the occurrence of either paresthesia (2 patients) or areflexia (1 patient). Our study shows that initially a 50-mg/day dose is efficacious in the treatment of OGU and that administration of one tablet every 2 or 3 days is efficacious in more than 60% of the patients to maintain remission. CONCLUSION: A dosage of 50 mg/day is initially efficacious in most cases, provided that the patient is carefully followed up to allow early detection of potential peripheral neuropathy.

Adult↗
PubMed1999

[Does a particular risk associated with papillomavirus infections exist in women with lupus?].

PURPOSE: There is strong evidence that papillomavirus infections (HPV), especially infections with HPV 16/18, are involved in the development of dysplasia and cancers. Cervical cancer is thought to be increased in women with systemic lupus erythematosus (SLE). METHODS: To assess this risk we studied cervical smears from 11 women with SLE and determined the prevalence of HPV infection by in situ hybridization. RESULTS: Dysplasia was found in 9% of women with SLE and in 0.03% of control subjects (non significant difference). Dysplasia was found to be six times more frequent in women with SLE (18% versus 3%, P < 0.01). HPV prevalence in normal smears was 37.5% in women with SLE versus 14.7% in control subjects (non-significant difference). Identified HPV genotypes were those for which intermediate or high risk is well established. No correlation was found between infection or dysplasia risk and the lymphocyte count or a previous treatment with cyclophosphamide. CONCLUSION: We conclude that women with SLE would be at increased risk of HPV infection, dysplasia and cervical cancer. We suggest that women with SLE should be regularly tested for cervical cancer by colposcopy, especially in case of HPV 16 infection.

Adult↗
PubMed1997

[Localizations and consequences].

The symptoms of amyloidosis depend on the type of precursor, the amount of deposits and their location. In systemic amyloidosis almost every organ may be involved. Cardiac involvement is severe, especially in AL amyloidosis, responsible for restrictive cardiomyopathy with right ventricular failure, leading rapidly to death. Renal amyloid deposition causes nephrotic syndrome with hypertension and renal failure. Neurological complications include peripheral neuropathy with dysautonomia cerebral involvement (dementia, cerebral haemorrhages). Arterial deposits are common in systemic senile amyloidosis, and may cause ischaemia. Osteo-articular damage is mainly seen in patients on long-term haemodialysis. Liver enlargement is often the only manifestation of hepatic amyloidosis. Digestive tract involvement includes macroglossia deposits in salivary glands and disturbances in gastrointestinal motility. Pulmonary amyloidosis causes nodular or interstitial infiltrates. Cutaneous lesions are various. Localized amyloidoses include goiter, breast and vesical involvement which can be difficult to differentiate from neoplasm, as well as ocular amyloidosis mimicking posterior uveitis.

Adult↗