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Biomedical subjects

S Alvarez

Publications and source records attributed to S Alvarez.

At least 145 records · Page 8Linked to original sources
PubMed1985

Klebsiella oxytoca isolates in a general hospital.

Primary infections caused by Klebsiella species are uncommon, but the organism is an important nosocomial pathogen. We report the predisposing factors, clinical features and outcome of 44 hospitalized patients in whom Klebsiella oxytoca was isolated. Twenty-one (48%) isolates were community-acquired and 23 (52%) were considered nosocomial in origin. Most of the patients were elderly males with serious underlying diseases. There were significant differences between those patients who acquired Klebsiella oxytoca in the hospital and in the community. Nosocomially acquired organisms were associated with a higher mortality (52% vs. 24%) (p less than 0.05), a higher incidence of infection vs. colonization (83% vs. 57%) (p less than 0.05), and a higher percentage of cases of pneumonia (43% vs. 19%) (p less than 0.05). The clinical features, the hospital service and the patients' underlying diseases were similar when patients who died and those who survived were compared. Patients who died were exposed to antibiotics more often prior to the positive culture with K. oxytoca (p less than 0.05). K. oxytoca is a significant pathogen in hospitalized elderly patients. It is likely to cause infections, especially pneumonia, and carry a high mortality. The organism can become endemic within the hospital setting with continued carriage and nosocomial spread.

Age Factors↗
PubMed1985

In vitro susceptibilities and beta-lactamase production of 53 clinical isolates of Branhamella catarrhalis.

We tested 53 clinical isolates of Branhamella catarrhalis recovered from patients with respiratory symptoms to determine the susceptibility of the isolates to 25 antimicrobial agents, including the newer beta-lactam antibiotics. Of the 53 strains, 46 (86.7%) were beta-lactamase producers. All the strains were susceptible to the majority of the new penicillins and cephalosporins. The combinations of amoxacillin-clavulanic acid and ticarcillin-clavulanic acid were also very active against the beta-lactamase-producing strains.

Anti-Bacterial Agents↗
PubMed1985

In vitro activity of fosfomycin, alone and in combination, against methicillin-resistant Staphylococcus aureus.

We tested 148 strains of clinical isolates of methicillin-resistant Staphylococcus aureus against fosfomycin alone and in combination with methicillin, cefamandole, gentamicin, trimethoprim, and vancomycin. Fosfomycin inhibited 90% of the 148 methicillin-resistant S. aureus strains at a concentration of 4 micrograms/ml. Synergism was observed in 97 strains (66%) with fosfomycin-cefamandole and in 69 strains (46%) with fosfomycin-methicillin. The combinations of fosfomycin with vancomycin, gentamicin, and trimethoprim were indifferent in most strains.

Cross Infection↗
PubMed1984

Pitfalls in the diagnosis of endometrial neoplasia.

One hundred consecutive cases of hyperplasia of the endometrium were referred to the Sloane Hospital for Women. The referral diagnoses and consultation diagnoses were compared for the purpose of analyzing common diagnostic problems in interpretation of endometrial hyperplasias and the use of diagnostic terminology as it applies to prognosis and therapy. The consultation diagnosis was a down grade of the original diagnosis in 69% of the reviewed cases. The most common endometrial pathology misinterpreted as hyperplasia was endometrial polyps, followed by the endometrial metaplasias, and architectural distortion caused by necrosis and mechanical artifact. In 14% of the referral diagnoses, the use of terminology was vague, with such terms as endometrial, epithelial, or glandular hyperplasia, and did not communicate the prognostic intent of the referring pathologist to the consulting physician. The careful use of endometrial diagnostic terms accompanied by a statement of the system of classification used and its corresponding clinical intent is suggested.

Adenocarcinoma↗
PubMed1984

Extrapulmonary tuberculosis revisited: a review of experience at Boston City and other hospitals.

During a 10-year period, 136 patients with extrapulmonary tuberculosis were seen at Boston City Hospital and other hospitals affiliated with Boston University School of Medicine. Review of these cases revealed that the prevalence of extrapulmonary tuberculosis was declining less rapidly than that of pulmonary disease. Extrapulmonary disease represented 4.5% of all new cases of active tuberculosis and tended to occur in older patients than in previous reports. Sites of involvement included lymph nodes, blood, genitourinary tract, bone and articular sites, the meninges, peritoneum, adrenal glands, pericardium, and miscellaneous sites, in this order. Diagnosis was confirmed by a variety of techniques whose relative merits are discussed. Overall, 14 deaths occurred among the 136 patients. One-half of the deaths resulted from causes other than tuberculosis and two patients died before diagnosis and initiation of therapy. Evaluation of the relative efficacy of therapeutic regimens was hampered by a high degree of recidivism in this population and the multitude of regimens utilized. These observations indicate that extrapulmonary tuberculosis still occurs with substantial frequency among patients seen in "inner-city" hospitals and that its recognition may be complicated by its occurrence in older patients with other medical conditions.

Adolescent↗
PubMed1981

[Taste disorders following ear surgery (author's transl)].

A prospective study of chorda tympany was carried out on 76 patients aging from 14 to 71 years by performing qualitative taste examination and electrogustometry prior to and at regular intervals up to 1 year after tympanoplasty. In 16 cases of preoperative ageusia, the chorda tympany was found to have been destroyed by cholesteatoma or during a previous ear surgery. Out of 27 cases, in which the chorda tympany remained intact during the surgery, nine patients suffered a mild hypogeusia up to 3 months after the operation. In 13 cases, in which the chorda tympany was stretched or distended during the operation, there existed a marred correlation between the degree of its manipulation and the electrogustometric abnormalities. A chorda tympany section was always followed by a postoperative ageusia.

Adolescent↗
PubMed1980

In vitro studies of moxalactam (LY127935), a new beta-lactam antibiotic with significant activity against gram-negative bacteria.

Moxalactam (LY127935) is a new beta-lactam antibiotic which is chemically related to the cephalosporins. The agent is highly active against the Enterobacteriaceae, with most organisms sensitive to 0.1 mcg/ml or less. It is also active at low concentration against gentamicin-resistant strains of Providencia and Serratia. Minimal inhibitory concentrations of moxalactam for Pseudomonas aeruginosa are approximately four-fold lower than those of carbenicillin for the same isolates. It is highly active against Hemophilus influenzae, including ampicillin-resistant strains, with all strains tested sensitive to 0.1 mcg/ml or less. The majority of strains of Neisseria gonorrheae and Neisseria meningitidis are sensitive to 0.1 mcg/ml or less. Moxalactam is more active against Bacteroides fragilis than cefoxitin. However, activity of moxalactam against gram-positive cocci was uniformly less than cephalothin and other cephalosporins tested. Little effect of inoculum size was observed with moxalactam except for particular strains of gram-negative bacilli. The drug was found to be 40-43% bound to human serum proteins.

Amikacin↗
PubMed1979

Drug therapy reviews: nitrofurantoin.

Mechanism of action, antimicrobial spectrum, pharmacology, adverse reactions and therapeutic uses of nitrofurantoin, a broad-spectrum antimicrobial agent, are discussed. The frequency and potential severity of reactions attributed to nitrofurantoin, plus its inability to achieve therapeutic blood concentrations, relegate this drug to a position of secondary importance. Nitrofurantoin compares favorably with other standard agents for the therapy of acute and recurrent urinary tract infections in women which may be caused by susceptible organisms, and it is an effective chemoprophylactic agent for patients with recurrent urinary tract infections. The compound has no apparent adverse effects on the developing fetus and can be used in pregnant women. This is not sanctioned by the package insert, however. Nitrofurantoin should not be administered when the possibility of bacteremia exists, as the drug does not achieve therapeutic serum levels when administered orally. Nitrofurantoin is contraindicated for patients with renal insufficiency. The value of this compound for men with acute urinary tract infection, recurrent urinary tract infection, acute bacterial prostatitis or chronic bacterial prostatitis has not been established. There are no indications for prescribing parenteral nitrofurantoin.

Adult↗
PubMed1979

Drug therapy reviews: trimethoprim-sulfamethoxazole.

The mechanism of action, antimicrobial spectrum, pharmacokinetic properties, drug interactions, adverse reactions and therapeutic uses of trimethoprim-sulfamethoxazole, a combination enzyme-specific inhibitor of bacterial folate synthesis, are reviewed. Trimethoprim-sulfamethoxazole currently is approved by the FDA for the therapy of established recurrent bacterial urinary tract infections, pneumocystosis, otitis media in children and shigellosis. Claimed advantages of the drug are synergistic activity, bactericidal activity and ability to decrease the rate of emergence of resistance to the individual components. Trimethoprim-sulfamethoxazole is the drug of choice for treatment of pneumocystosis and an acceptable oral therapy for recurrent urinary tract infections caused by susceptible bacteria. In children with otitis media, it is used as an alternative to ampicillin and amoxicillin and is preferred when these patients are penicillin-sensitive or when the infection is caused by beta-lactamase-producing Haemophilus influenzae. Hematologic reactions (anemia, thrombocytopenia, granulocytopenia, agranulocytosis) to trimethoprim-sulfamethoxazole occur rarely. Gastrointestinal intolerance and skin eruptions are the most prevalent adverse reactions. Most untoward reactions to trimethoprim-sulfamethoxazole develop within two weeks of onset of therapy, and their incidence compares favorably with that of standard agents administered for the same indications.

Acute Disease↗
PubMed1979

Drug therapy reviews: methenamine mandelate and methenamine hippurate.

The mechanism of action, spectrum of antimicrobial activity, pharmacokinetics, adverse effects, therapeutic use, and dosage of methenamine hippurate and methenamine mandelate are reviewed. The antimicrobial activity of methenamine depends on its conversion in the urine to formaldehyde. Formaldehyde's spectrum of antibacterial activity encompasses all urinary tract pathogens. Urinary concentrations of formaldehyde vary with pH and urine volume; however, there is no documentation that acdification of the urine enhances methenamine's therapeutic activity. Adverse reactions to methenamine, including gastrointestinal intolerance and skin reactions, are mild and reversible and occur infrequently. Methenamine mandelate and hippurate are effective in the prevention of recurrent urinary tract infections except in patients with Foley catheters or who require intermittent catheterization.

Bacteria↗
PubMed1978

Non-invasive assessment of left internal mammary-coronary bypass patency using the external Doppler probe.

Non-directional blood velocity of left internal mammary bypass grafts was non-invasively studied with the Doppler ultrasonic probe. Thirteen of 14 subjects had angiographic evidence of bypass graft patency and their Doppler signals demonstrated high amplitude phasic blood velocities. A single patient with proximal left internal mammary arterial graft occlusion manifested marked attenuation of Doppler blood velocity signals. It is concluded that this technic offers a potential for ambulatory and in-office screening of internal mammary artery bypass graft function.

Blood Flow Velocity↗