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Biomedical subjects

V Falcó

Publications and source records attributed to V Falcó.

At least 19 recordsLinked to original sources
PubMed2004

Evaluation of a latex agglutination test (KAtex) for detection of Leishmania antigen in urine of patients with HIV-Leishmania coinfection: value in diagnosis and post-treatment follow-up.

The usefulness of antigen detection in urine as an alternative tool for diagnosis of leishmaniasis and post-treatment follow-up in patients with Leishmania-HIV coinfection was evaluated with a latex agglutination test (KAtex; Kalon Biological, UK). Forty-nine HIV-infected patients with visceral leishmaniasis were included in the study. Antigen detection in urine (ADU) was positive in 42 of 49 (sensitivity, 85.7%) samples obtained during a primary episode. After treatment, a follow-up study in 23 patients was performed by simultaneous ADU and culture of peripheral blood mononuclear cells in 148 determinations. The two methods gave concordant results in 94 cases, 38 of which were positive and 56 negative. In five cases, ADU was negative and culture of peripheral blood mononuclear cells was positive: two of these cases corresponded to clinical relapses. In 49 cases, culture of peripheral blood mononuclear cells was negative and ADU was positive. In the absence of clinical symptoms, the detection of parasite antigens in 71 of 130 (54.6%) urine samples was not associated with clinical disease. The Kaplan-Meier estimates of the probability of relapse at 6, 12, 18, and 24 months were 16% (95%CI, 15-17%), 20% (95%CI, 18-22%), 31% (95%CI, 27-35%), and 71% (95%CI, 52-89%), respectively, in patients with a positive ADU result. In contrast, when ADU was negative, the probability of relapse was 5% at 6 months (95%CI, 2-8%) (only 2 of 11 patients who relapsed had a negative test). ADU by KAtex is appropriate for primary diagnosis of visceral leishmaniasis, for monitoring the efficacy of treatment, and for detection of subclinical infection.

AIDS-Related Opportunistic Infections↗
PubMed2003

A case of multiorgan failure following interruption of antiretroviral treatment.

Reported here is an exceptional case of acute retroviral syndrome resembling septic shock that occurred in a chronic HIV-infected patient shortly following planned interruption of antiretroviral treatment. The therapeutic strategy, which is aimed at improving the immunological control of HIV infection, can therefore be deleterious in chronically infected patients and should be avoided outside of closely monitored clinical trials.

Adult↗
PubMed2002

Accuracy of high-resolution CT in distinguishing between Pneumocystis carinii pneumonia and non- Pneumocystis carinii pneumonia in AIDS patients.

The aim of this study was to assess the value of high-resolution CT in distinguishing between Pneumocystis carinii and non- Pneumocystis carinii pneumonia (PCP) in patients HIV-positive and high risk to have PCP. We performed a prospective study in 30 patients with <200 CD4 lymphocytes, clinical symptoms of pulmonary disease and chest X-ray non-conclusive for pulmonary infection. Evaluated CT findings included ground-glass opacities, reticulation, tree-in-bud appearance, consolidation, cystic lesions, bronchiectasis and lymphadenopathies. The diagnosis of "examination suggestive of PCP" was applied to cases showing a diffuse or predominant ground-glass pattern in the upper fields, associated or not with reticulations and small cystic lesions. The sensitivity, specificity, positive predictive value and negative predictive value of high-resolution computed tomography (HRCT) for the diagnosis of PCP was 100, 83.3, 90.5 and 100%, respectively. Pneumocystis carinii pneumonia was not demonstrated in any of the cases classified as "examination not suggestive of PCP". Significant small airway disease was not observed in any of the PCP cases. We conclude that HRCT is a reliable method for differentiating PCP from other infectious processes in HIV-positive patients and a good method to rule our PCP. Its inclusion in the diagnostic algorithm of lung infections is justified in these patients.

AIDS-Related Opportunistic Infections↗
PubMed2001

[Tumors diagnosed in 65 patients with type I neurofibromatosis].

BACKGROUND: Type 1 neurofibromatosis patients develop malignant neoplasm more frequently than general population. PATIENTS AND METHOD: We have studied 65 patients with neurofibromatosis type 1 because we intend to know the kind of neoplasms that they have presented. RESULTS: 65 patients (48 men and 17 women) fulfilling type 1 neurofibromatosis criteria have been studied. Globally 67 tumors appeared, from which 47 (70%) were benign and 20 (30%) were malignant. Benign tumors included 25 neurofibromas, 11 central nervous system tumors and 11 extraneurological tumors. Malignant tumors accounted for 6 soft tissue sarcomas, 6 carcinomas, 3 malignant CNS tumors and 2 acute lymphoblastic leukemias. CONCLUSION: Presentation of neoplasms is frequent in type 1 neurofibromatosis and constitutes main death and morbility cause.

Aged↗
PubMed2001

Efficacy of teicoplanin-gentamicin given once a day on the basis of pharmacokinetics in humans for treatment of enterococcal experimental endocarditis.

With the aim of investigating home therapy for enterococcal endocarditis, we compared the efficacy of teicoplanin combined with gentamicin given once a day or in three daily doses (t.i.d.) with the standard treatment, ampicillin plus gentamicin administered t.i.d., for treating experimental enterococcal endocarditis. The antibiotics were administered by using "human-like pharmacokinetics" (H-L), i.e, pharmacokinetics like those in humans, that simulated the profiles of these drugs in human serum. Animals with catheter-induced endocarditis were infected intravenously with 10(8) CFU of Enterococcus faecalis EF91 (MICs and MBCs of ampicillin, gentamicin, and teicoplanin, 0.5 and 32, 16 and 32, and 0.5 and 1 microg/ml, respectively) and were treated for 3 days with ampicillin H-L at 2 g every 4 h plus gentamicin H-L at 1 mg/kg every 8 h, or teicoplanin H-L at 10 mg/kg every 24 h, alone or combined with gentamicin, administered at dose of H-L at 1 mg/kg every 8 h or H-L at 4.5 mg/kg every 24 h. The results of therapy for experimental endocarditis due to EF91 showed that teicoplanin alone was as effective as ampicillin alone in reducing the bacterial load (P > 0.05). The combination of ampicillin or teicoplanin with gentamicin was more effective than the administration of both drugs alone in reducing the log(10)CFU/gram of aortic vegetation (P < 0.01 and P < 0.05, respectively). Teicoplanin plus gentamicin H-L at 4.5 mg/kg, both administered every 24 h, showed an efficacy equal to the "gold standard," ampicillin plus gentamicin H-L at 1 mg/kg t.i.d. (P > 0.05). Increasing the interval of administration of gentamicin to a single daily dose combined with teicoplanin resulted in a reduction of bacteria in the vegetations equivalent to that achieved with the recommended regimen of ampicillin plus thrice-daily gentamicin in the treatment of experimental endocarditis due to E. faecalis. Teicoplanin plus gentamicin, both administered once a day, may be useful home therapy for selected cases of enterococcal endocarditis.

Animals↗
PubMed2000

Diagnostic accuracy of pleural fluid polymorphonuclear elastase in the differentiation between pyogenic bacterial infectious and non-infectious pleural effusions.

BACKGROUND AND OBJECTIVES: To establish the diagnostic accuracy of the markers of neutrophil activity (elastase and lysozyme) determined in pleural fluid, for differentiating between pyogenic bacterial infectious and non-infectious pleural effusions. PATIENTS AND METHODS: At our tertiary referral teaching hospital, 160 patients over 14 years with pleural effusion (PE), classified as pyogenic bacterial infectious (41 parapneumonic complicated, 32 parapneumonic non-complicated) and non-infectious (32 neoplasm and 55 undiagnosed pleural exudates) were examined in a prospective study. Polymorphonuclear elastase (PMN-E) was determined by an immunoactivation method and lysozyme by a turbidimetric method. Receiver operating characteristic (ROC) curves were used to evaluate diagnostic accuracy. RESULTS: Pleural fluid PMN-E was the biochemical marker that best differentiated between pyogenic bacterial infectious and non-infectious PE. The ROC area under the curve (AUC) for PMN-E was 0.8276. A PMN-E value over 230 microg/l diagnosed infectious PE with a specificity of 0.81 and a sensitivity of 0.74. The ROC AUC for proteins plus lactate dehydrogenase was 0. 7430. Differences between the two ROC curves were significant (p = 0. 032). After excluding purulent parapneumonic complicated PE, the sensitivity of a pleural fluid PMN-E value equal to or greater than 230 microg/l was 0.64 and the specificity 0.81. CONCLUSIONS: Pleural fluid PMN-E was the marker that best differentiated infectious from non-infectious PE, and PMN-E values lower than 230 microg/l suggest non-infectious PE.

Adolescent↗
PubMed1999

The value of chest roentgenography in the diagnosis of pneumothorax after thoracentesis.

PURPOSE: We sought to assess the yield of chest roentgenography for the detection of pneumothorax among hospitalized patients with pleural effusion who have undergone diagnostic or therapeutic thoracentesis. SUBJECTS AND METHODS: We performed a prospective study of 506 thoracentesis procedures in 370 patients. After the procedure, each operator filled out a note recording patient data and the characteristics of the thoracentesis. A chest radiograph was performed within 12 hours after the procedure in all patients. RESULTS: Eighteen (4%) pneumothoraces occurred in 17 patients, 9 (2%) of which required chest tube drainage. Of the 488 patients without symptoms, only 5 (1%) developed a pneumothorax, only 1 of which required chest tube drainage. By contrast, of the 18 patients with symptoms, 13 developed a pneumothorax, 8 of which required chest tubes. There were two independent predictors of pneumothorax: presence of symptoms (odds ratio [OR] = 250; 95% confidence interval [CI]: 65 to 980) and male gender (OR = 5.4; 95% CI: 1.9 to 69). CONCLUSIONS: Among the symptom-free patients in our sample, the risk of developing pneumothorax with clinical consequences was so low that the practice of routine chest roentgenography may not be justified.

Chest Tubes↗
PubMed1996

[Esophageal candidiasis in patients without cellular immunity changes. Report of 7 cases].

OBJECTIVE: To study the clinical and immunological features of esophageal candidiasis in patients with no changes in cellular immunity. PATIENTS AND METHODS: Seven patients with the endoscopic diagnosis of esophageal candidiasis were studied and in no patient were changes in cellular immunity detected. An investigation was carried out of the presence of antibodies to the human immunodeficiency virus antigen, lymphocyte populations, complement, and immunoglobulins. RESULTS: Seven male patients with a mean age of 57 years (range: 43-67 years) and no underlying diseases were studied. The symptom at presentation in all cases was dysphagia and odynophagia of several days; two patients had also retro-sternal pain and one of them upper digestive hemorrhage. The digestive endoscopy showed white confluent patches highly suggestive of esophageal candidiasis. Therapy with intravenous fluconazole was started and both the clinical course and endoscopic lesions had a favorable outcome. Antibodies and antigen of human immunodeficiency virus were negative. Lymphocyte populations, complement, and immunoglobulins were normal in all patients but one, in whom a severe IgG hypogammaglobulinemia was detected. COMMENT: Esophageal candidiasis, though rare, is an entity to be considered in immunocompetent patients or with no changes in cellular immunity.

Adult↗
PubMed1994

Bacterial pneumonia in HIV-infected patients: a prospective study of 68 episodes.

We collected clinical and microbiological observations, as well as follow-up on human immunodeficiency virus (HIV)-infected patients with bacterial pneumonia, and compared pneumococcal pneumonia in patients with and without HIV infection. Fifty five HIV-infected patients, who had had 68 episodes of bacterial pneumonia, were studied prospectively. Twenty one HIV-infected patients with pneumococcal pneumonia were compared to 69 non-HIV-infected patients with pneumococcal pneumonia. Aetiological diagnosis was established in 48 cases (71%). The most common causative agents were S. pneumoniae and H. influenzae. Sixty percent of episodes took place in asymptomatic carriers of HIV infection and 37% in acquired immune deficiency syndrome (AIDS) patients. Overall mortality was 10%. Fifty five percent of patients with follow-up had recurrent episodes. Bacteraemic pneumococcal pneumonia was more frequent in HIV- than in non-HIV-infected patients, and the mortality of pneumococcal pneumonia was also higher in HIV- (19%) than in non-HIV-infected (4.3%) patients. We conclude that bacterial pneumonia is a frequent problem in HIV-infected patients and that recurrent episodes are common. The clinical presentation of pneumococcal pneumonia is generally indistinguishable from that occurring in normal hosts, but bacteraemia is more common and the mortality is higher in HIV-infected patients.

AIDS-Related Opportunistic Infections↗
PubMed1994

[Isolation of Haemophilus spp. from samples of pleural fluid: 11 years' review].

BACKGROUND: The incidence and significance of Haemophilus spp. in plural fluid were retrospectively studied over a period of 11 years. METHODS: Gram staining and culture in aerobic and anaerobic media was performed in 7517 pleural fluids. Haemophilus spp. was identified with the AMS-Vitek and/or conventional systems. The presence of beta-lactamase was assessed by this method or by the acidometric method. RESULTS: Haemophilus spp. was identified in 72 samples (0.9%) corresponding to 37 patients. The medical records of 22 were reviewed. The most common species isolated was H. influenzae. Gram stain exam was positive on 28 occasions (38.8%), with gram-negative bacilli being observed in 78.5%. A pure culture was obtained in 43 samples with anaerobic bacteria associated in 18% of the cases. Only 10 strains (16.4%) produced beta-lactamase. No predominance of any determined biotype was observed. Most of the patients were male with a mean age of 59.2 years (range: 2-82). Seventeen patients presented with community-acquired pneumonia, as well as tuberculous sequelae, pneumonectomy and pulmonary and/or upper GI truct neoplasms. All were treated with antibiotics, beta-lactam drugs alone or with aminoglycosides. Half of them also required surgical drainage. Four patients died in relation with the underlying disease. CONCLUSIONS: Haemophilus spp. was isolated in 7.7% of 7517 samples of pleural fluid. This finding may indicate the coexistence of an underlying thoracic disease of neoplastic origin.

Adolescent↗
PubMed1992

[Varicella pneumonia in adults. Study of 13 cases].

Clinical and therapeutic features of 13 adult patients, diagnosed of Pneumonia Varicellosa are retrospectively reviewed, for the last ten years period, at Valle de Hebron General Hospital, Barcelona. Most of them had a cigarette consumption of over 20 per day, three of them showed simple chronic bronchitis criteria, and two had antibodies against HIV. Respiratory symptomatology, and dry cough, was present in 9 (75%), dyspnea in 7 (53%) and pleuritic pain in 6 (46%). Thorax radiology showed a bilateral interstitial pattern. IV aciclovir treatment was begun in patients with respiratory symptoms and hypoxemia (53%) with good therapeutic response.

Adolescent↗