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Biomedical subjects

B Padilla

Publications and source records attributed to B Padilla.

At least 19 recordsLinked to original sources
PubMed2002

Demolition of a hospital building by controlled explosion: the impact on filamentous fungal load in internal and external air.

The demolition of a maternity building at our institution provided us with the opportunity to study the load of filamentous fungi in the air. External (nearby streets) and internal (within the hospital buildings) air was sampled with an automatic volumetric machine (MAS-100 Air Samplair) at least daily during the week before the demolition, at 10, 30, 60, 90,120, 180, 240, 420, 540 and 660 min post-demolition, daily during the week after the demolition and weekly during weeks 2, 3 and 4 after demolition. Samples were duplicated to analyse reproducibility. Three hundred and forty samples were obtained: 115 external air, 69 'non-protected' internal air and 156 protected internal air [high efficiency particulate air (HEPA) filtered air under positive pressure]. A significant increase in the colony count of filamentous fungi occurred after the demolition. Median colony counts of external air on demolition day were significantly higher than from internal air (70.2 cfu/m(3) vs 35.8 cfu/m(3)) (P < 0.001). Mechanical demolition on day +4 also produced a significant difference between external and internal air (74.5 cfu/m(3) vs 41.7 cfu/m(3)). The counts returned to baseline levels on day +11. Most areas with a protected air supply yielded no colonies before demolition day and remained negative on demolition day. The reproducibility of the count method was good (intra-assay variance: 2.4 cfu/m(3)). No episodes of invasive filamentous mycosis were detected during the three months following the demolition. Demolition work was associated with a significant increase in the fungal colony counts of hospital external and non-protected internal air. Effective protective measures may be taken to avoid the emergence of clinical infections.

Air Conditioning↗
PubMed2001

Inflammatory reactions in progressive multifocal leukoencephalopathy after highly active antiretroviral therapy.

Three patients with progressive multifocal leukoencephalopathy (PML) treated with highly active antiretroviral therapy (HAART) worsened clinically and radiologically. At the time of deterioration all three had reduced HIV viraemia and increased CD4 cell counts. Brain biopsy in all three disclosed PML and marked perivascular lymphoplasmacytic infiltration. We reviewed the slides of 28 brain biopsies diagnostic of PML. Inflammatory changes were observed in four out of nine patients on HAART and in one out of 19 patients not on HAART.

AIDS-Related Opportunistic Infections↗
PubMed2000

Use and misuse of antimicrobial agents in a general hospital in the AIDS era.

A prevalence study was carried out to ascertain the pattern of antimicrobial use, costs and relevance in a general hospital during the AIDS era. All patients receiving antimicrobials were studied. Antimicrobials were divided into antibacterial drugs and others and the costs evaluated in US dollars. Of 1526 patients surveyed, 455 (29.8%) were receiving 664 courses of antimicrobials: 109 (7.2%) as prophylaxis and 346 (22.6%) as treatment. Fifteen percent of courses involved non-antibacterial drugs. In 188 patients (40.9% of those treated) treatment was inadequate, usually because of incorrect drug choice. Daily cost of antimicrobials was $14953. AIDS accounted for 3% of all patients, 9% of those receiving antimicrobials, 19.7% of antimicrobial usage and 9.6% of the antimicrobial expenditure. Misuse occurred in 43% of non-HIV patients and 17% of those with HIV. Thus, despite a disproportionate contribution of patients with AIDS, adequacy of use of antimicrobials was better in this population.

AIDS-Related Opportunistic Infections↗
PubMed1998

Treatment of AIDS-associated progressive multifocal leukoencephalopathy with highly active antiretroviral therapy.

OBJECTIVES: To evaluate the efficacy of highly active antiretroviral therapy (HAART) in 12 patients with AIDS-associated progressive multifocal leukoencephalopathy (PML). PATIENTS AND METHODS: The diagnosis of PML was established by brain biopsy in six patients and by neuroimaging findings and PCR detection of JC virus in cerebrospinal fluid (CSF) in six patients. We also studied 13 consecutive AIDS patients with biopsy-proven PML cared for in the same institution before HAART was available. Eleven patients of the HAART group and eight patients of the control group received intravenous arabinoside cytosine cycles. RESULTS: With HAART, the median decrease in the HIV viral load was 3.58 log10 copies/ml and the median increase in the CD4 cell count was 74x10(6)/l. The median survival time after PML diagnosis was 545 days in the HAART group and 60 days in the control group (P<0.001, log-rank test). In the HAART group, the neurological deficits improved substantially in six patients and stabilized in six patients. Eleven patients underwent follow-up cranial computed tomography or magnetic resonance scan that showed improvement of PML lesions in 10 patients and stabilization in one patient. Follow-up CSF analysis showed clearance of JC virus in six out of seven patients who had an initial positive result. CONCLUSIONS: This study shows that HAART may increase the survival, clinical status and radiological features of AIDS patients with PML. Clearance of JC virus from CSF has been found, suggesting that immune reconstitution can interrupt the JC virus lytic cycle.

AIDS-Related Opportunistic Infections↗
PubMed1998

Visceral leishmaniasis (Kala-Azar) in transplant recipients: case report and review.

BACKGROUND: In endemic areas, visceral leishmaniasis has been identified as an opportunistic infection in patients with derangements in their cellular immune system. METHODS: We report a renal transplant patient with visceral leishmaniasis. We also reviewed the previously published cases of 17 organ transplant recipients with this parasitic disease. RESULTS: Visceral leishmaniasis occurred a median time of 8 months after transplantation, and the clinical picture was characterized by fever, splenomegaly, and blood cytopenias. Leishmaniae were detected in bone marrow in 16 of 18 patients and diagnostic serology results were found in 8 of 10 tested patients. Pentavalent antimonials were used to treat 16 patients, five of which developed pancreatitis. Five of 18 patients died, including two untreated patients. Relapses of visceral leishmaniasis occurred in 4 of 13 survivors. CONCLUSIONS: In endemic areas, visceral leishmaniasis may complicate the clinical course of organ transplantation and can have fatal consequences, particularly when untreated.

Animals↗
PubMed1998

[Need for systematic HIV serological study during pregnancy].

BACKGROUND: To evaluate human immunodeficiency virus (HIV) screening usefulness in pregnancy and to know the prevalence of this infection in an urban area of Spain. PATIENTS AND METHOD: Routine prenatal screening for antibodies to HIV was offered to pregnant women from Fuenlabrada-Leganés Health Care Area (Madrid) from 1992 to 1995. Unlinked anonymous screening of HIV was done with the sera from women refusing the assay or if it had not been offered. RESULTS: HIV prevalence was 0.28% (CI: 95%; 0.19 to 0.40) in the 11.021 pregnant women group studied. 87.1% pregnant seropositive women were detected by consented screening. 55.6% of them recognized risk behavior (73.33% by intravenous drug use) and 44.4% did not do it. With a second anamnesis in this group 75% admitted risk conducts and 25% confirmed their ignorance about them. CONCLUSIONS: HIV seropositive screening in pregnant women selected only by risk behavior may be unsuccessful. For that reason, it is more convenient the perform a routine test for detection of HIV antibodies after informed consent in high prevalence areas of HIV infection.

AIDS Serodiagnosis↗
PubMed1997

Outbreak among HIV-infected patients of Staphylococcus aureus resistant to cotrimoxazole and methicillin.

OBJECTIVE: To describe an outbreak of trimethoprim-sulfamethoxazole (cotrimoxazole)-resistant and methicillin-resistant Staphylococcus aureus (CMRSA) in a unit housing patients infected with the human immunodeficiency virus (HIV). DESIGN: Prospective study involving patients colonized or infected with CMRSA. PATIENTS: 15 hospitalized patients with cultures positive for CMRSA. METHODS: Isolates of CMRSA were collected and characterized. Molecular typing of the epidemic strains was carried out after total DNA extraction by restriction endonuclease analysis and random amplification of polymorphic DNA. RESULTS: The epidemic was brought under control with the reinforcement of nosocomial transmission measures and with systematic nasal decontamination with mupirocin of all patients admitted to the HIV unit. Molecular typing techniques showed the existence of two epidemic strains: strain A was present in the 12 patients admitted to the HIV unit and strain B in the remaining 3 patients hospitalized elsewhere. CONCLUSIONS: Cotrimoxazole may no longer be a reliable and effective alternative for glycopeptides in patients with infection caused by MRSA strains, and HIV units should be particularly alert for CMRSA strains.

Adult↗
PubMed1996

[Diarrhea associated with Clostridium difficile: one-year experience in a general hospital].

Clostridium difficile is considered the most common cause of nosocomial acquired diarrhoea, with frequencies differing widely from one institution to another. So far, it is a scarcely reported condition in Spain. In the present study 129 episodes of Clostridium difficile associated diarrhoea (CDAD) occurred in 120 patients in a 2,000-bed hospital in 1994 is reported. All cases were diagnosed by demonstrating cytotoxicity on cellular lines (MRC-5) from feces or from the strain isolated from a culture medium (CCFA). The overall incidence was 2.4 episodes every 1,000 admissions. Twenty-eight out of the 120 patients (23%) were HIV-positive patients, that is, an incidence of 30 episodes every 1,000 admissions. No significant differences were observed regarding the presentation and clinical course between HIV-positive and HIV-negative patients, with the exception of the antimicrobial agents used previously. Forty-two percent of patients had undergone surgery and 97% had received antimicrobials in the 8 weeks before the CDAD episode, with an average of 3.3 antibiotics per patient. Out of the 129 episodes, 72.8% were treated correctly. A total of 11.7% of patients responded exclusively to the discontinuation of the antimicrobials that were being administered. Eighty-three patients were treated with specific antibiotics, 59 with oral vancomycin, and 24 with metronidazole. Seventy-six patients (91.5%) responded to the initial therapy, 5 relapsed (6%), and 2 (2.5%) failed. The associated mortality rate was 0.7%. C. difficile can be a relevant cause of nosocomial diarrhoea in our setting, particularly in HIV-positive patients, but also in other patients. Its early diagnosis and appropriate therapy can contribute to decrease a relevant cause of morbidity in inpatients.

Anti-Bacterial Agents↗
PubMed1994

Pancreatitis in patients with end-stage renal disease.

In a population of 716 patients with end-stage renal disease (ESRD), 46 patients (6.4%) were identified as having pancreatitis. Pancreatitis was significantly more common in those with alcohol abuse, systemic lupus erythematosus (SLE), and polycystic kidney disease. It was not significantly associated with hyperlipidemia, biliary tract disease, or hypercalcemia. Acute pancreatitis occurring before the patient developed ESRD was mainly alcohol-related and did not appear to be a significant risk factor for future episodes of pancreatitis during dialysis. Chronic calcific pancreatitis diagnosed before ESRD was almost invariably due to alcohol abuse, and tended to be a marker for recurrent acute exacerbation after development of ESRD, whether alcohol consumption continued or not. Pancreatitis occurring for the first time after ESRD in patients on dialysis was generally benign, and was usually accompanied by an uneventful recovery and few recurrent episodes. However, a significant elevation of the calcium x phosphate product was observed in these patients, occurring in about half the patients without any known precipitating factor. After kidney transplantation, the development of pancreatitis was associated with higher morbidity and mortality. Chronic calcific pancreatitis diagnosed after ESRD occurred only in patients with SLE; reported here for the first time, it may be a manifestation of long-standing disease, chronic steroid therapy, or both.

Acute Disease↗
PubMed1993

[The prevalence of Escherichia coli susceptibility to quinolones and other antibiotics in community-acquired bacteriurias in Madrid].

BACKGROUND: The empiric treatment of extrahospitalary urinary infections must keep in mind the patterns of susceptibility of the potentially causative bacteria. The consumption of antibiotics is one of the most important causes of change in the susceptibility of the bacteria. The recent introduction of fluorquinolones and the widespread use of those antibiotics makes knowledge of new patterns of sensitivity necessary in order to determine whether there are changing sensitive pattern among the different geographic zones. METHODS: During a period of two weeks randomly chosen 379 strains of Escherichia coli isolated from extrahospitalary bacteria were collected in 11 laboratories in 4 health areas in Madrid. Sensitivity to 11 antibiotics, including four of the quinolone group was determined by the agar dilution method. The existence of significant differences of sensitivity among the different areas was analyzed by the chi 2 test. RESULTS: The prevalence of sensitivity to ampicillin and cotrimoxazol was 42 and 73% respectively. Nineteen percent of the strains were resistant to amoxycillin/clavulanic acid. No strain was found to be resistant to cefotaxime. Four percent of the sample studied was not sensitive to the new fluorquinolones and almost 10% were resistant to nalidixic acid latter having decreased sensitivity to the fluorquinolones. No significant differences were observed in sensitivity among the areas, except with amoxycillin/clavulanic acid and cotrimoxazole. CONCLUSIONS: The high prevalence of the resistance of E. coli to ampicillin recently leads to the recommendation of its use in empiric treatments of urinary infections. In the zone in Madrid studied a high prevalence of resistance and decreased sensitivity of E. coli to fluoroquinolones was observed. It is therefore advisable to moderate their use to thereby prolong use over time.

4-Quinolones↗
PubMed1993

[Infection by HIV and the hepatitis B, C, and D viruses in intravenous drug addicts. Seroprevalence at 1 year and its follow-up].

BACKGROUND: The aim of the present article was to study the serology of intravenous drug user patients against the hepatitis B, C, D, and HIV, during 1990 and the follow-up during the same year, and 1991. METHODS: A study of 265 patients (mean age: 25 years, range: 16-45; 206 males and 59 females) was carried out. Forty-two percent came because of detoxication treatment, 30% requested diagnosis for hepatic disturbances and the only data provided in 28% were that they were intravenous drug users. None of the patients was an inmate from prisons. RESULTS: Seroprevalences were 67.5% for the HBV, 75.6% for HCV, 17% for HDV and 50.2% for HIV. In the patients seronegative for HBV (65%) and HIV (58%) no new serologic controls were performed during the study period, while in those who underwent controls the rates of seroconversion were 43.3% and 32%, respectively. In 30% of all seroconversions to HBV coinfection with HDV was found and in 23% antibodies against HIV were observed. CONCLUSIONS: Due to the high rates of infection obtained, the authors believe that serologic follow up of intravenous drug users is advisable.

Adolescent↗
PubMed1991

Fiberoptic bronchoscopic diagnosis of pulmonary disease in 151 HIV-infected patients with pneumonitis.

In a prospective study the efficacy of fiberoptic bronchoscopy was evaluated in the diagnosis of infections with opportunistic pathogens, Kaposi's sarcoma and nonspecific interstitial pneumonitis in 171 episodes of pneumonitis in 151 HIV-infected patients. Samples were collected by suction through the inner aspiration channel of the bronchoscope (n = 164), telescoping plugged catheter (n = 117) and transbronchial lung biopsy (n = 82). A high incidence of infections with pyogenic bacteria (12%), Legionella spp. (5 %) and Mycobacterium tuberculosis were diagnosed (9%). Bronchoalveolar lavage demonstrated a high diagnostic rate in bacterial pneumonia (significance level greater than 10(5) cfu/ml) and a low degree (10%) of contamination (less than 1% squamous epithelial cells). Bronchoalveolar lavage was more effective than the telescoping plugged catheter in yielding a significant number of colonies in patients with bacterial pneumonia previously treated with antibiotics. Nondiagnosed pneumonitis was more frequent in intravenous drug abusers than in homosexual men (p less than 0.001).

Adult↗