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M Gonzalez-Delgado

Publications and source records attributed to M Gonzalez-Delgado.

7 recordsLinked to original sources
PubMed2004

Evaluation of once daily tobramycin dosing in critically ill patients through Bayesian simulation.

OBJECTIVE: To evaluate if once-daily dose (ODD) regimens of tobramycin attain pharmacodynamic goals using individualized pharmacokinetic monitoring of critically ill patients with creatinine clearance (Clcr) over 60 mL/min. METHODS: Fifty-one adult critically ill patients treated with intravenous tobramycin with ODD were included in the study. The effect of dosing using the proposed method was compared with a weight-based (7 mg/kg) dosing method. Pharmacokinetics parameters, peak concentration (Cpeak), minimum concentration (Cmin) and the time below the minimum inhibitory concentration (MIC) were estimated using Bayesian analysis. Pharmacodynamic parameters used to evaluate both dosing regimens were Cpeak/MIC ratio and, secondly, time below MIC (T< MIC). RESULTS: The median dose of tobramycin administrated in our hospital was too low for achieving pharmacodynamic goals. In contrast, the weight-based (7 mg/kg) method produced an adequate Cpeak/MIC ratio but an increase of the dose would not reduce the secondary pharmacodynamic index T 60 mL/min achieved the Cpeak/MIC target values of 10. However in critically ill patients with Clcr>80 mL/min, T<MIC is greater than the aminoglycoside post-antibiotic effect, so these patients do not attain the secondary pharmacodynamic index. These data show the need for rapid pharmacokinetic optimization with individualized aminoglycoside dosing. Additional studies are necessary to better define the best tobramycin regimen for critically ill patients.

Anti-Bacterial Agents↗
PubMed2004

[Charles Bonnet's syndrome].

Charles Bonnet's syndrome is characterized by the existence of visual hallucinations without psychiatric manifestations or cognitive disorder. Most patients are elderly people with severe visual problems. The objective of this paper is to describe the cases of three patients with this syndrome. The first is an 87 year old woman with bilateral cataract who had visual hallucinations seeing women and faces. The second is another 87 year old woman with advanced myopia and visions of people, animals and objects. The third is a 52 year old woman with atypical pigmentary retinopathy who suffered visual hallucinations of objects and animals in color. The neuroimaging and neurophysiological studies were not contributory. Treatment with neuroleptics or antiepileptics was effective only in one case. We conclude that it is important to know the syndrome and to differentiate it from psychiatric semiology. Deafferentation of the visual cortex could be the decisive factor in the occurrence of visual hallucinations.

Aged↗
PubMed2004

[Ring chromosome 20: a distinctive syndrome identifiable by electroclinical diagnosis].

The ring chromosome 20 syndrome is characterized by treatment resistant non-convulsive status epilepticus, and slow waves intercalated by spikes/spike waves predominantly in the front-temporal regions. Here, we describe the case of an 18 year old patient, whose seizures began at the age of 10, these being resistant to treatment. Neurologic examination and cranial MRI were normal. Interictal EEG showed normal background activity with burst of 2-20 seconds with bilateral spike wave. Ictal EEG showed continuous paroxysmal activity with generalized spike waves discharges and slow delta waves, coinciding with nonconvulsive status epilepticus. After 1 mg of intravenous clonazepam, both clinical semiology and EEG abnormalities disappeared. A cytogenetic study showed ring chromosome 20 in 35 % of metaphases. The epilepsy associated with ring chromosome 20 constitutes a syndrome with its distinctive electroclinical characteristics.

Adolescent↗
PubMed2000

Kinetic alteration of theophylline at therapeutic doses.

OBJECTIVE: To report a case of a patient diagnosed as having bronchial asthma treated with intravenous infusion of theophylline, who presented an episode of altered theophylline metabolism with a disproportionately increase in serum concentrations together with tachycardia and symptoms of intoxication. CASE SUMMARY: A 51-year-old white woman with a history of bronchial asthma was treated with intravenous infusion of theophylline in an Intensive Care Unit. Bayesian pharmacokinetic approach for dose individualization was done and linear kinetics of theophylline were observed. At therapeutic dose, an alteration of theophylline metabolism had happened, that induced a decrease on the theophylline clearance coinciding with an increase of dose. The serum concentration at this dose was 23.9 microg/ml and this was associated with symptoms compatible with intoxication by theophylline. All factors that could change theophylline elimination were analyzed. A possible drug interaction, hypothyroidism and cardiac failure were ruled out. Clinical hepatic insufficiency was not determined, but an increase of hepatic enzymes was observed. Theophylline infusion was suspended during 5 hours, the serum levels returned to therapeutic values and hepatic enzymes returned to their initial values. DISCUSSION: Episodes of anormal theophylline kinetics may occur, even with doses and serum concentrations considered to be therapeutic, especially in critically ill patients or those whose physical condition has deteriorated. This makes it necessary to carry out therapeutic drug monitoring of theophylline in this group of the population.

Asthma↗