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E Navas

Publications and source records attributed to E Navas.

At least 55 records · Page 3Linked to original sources
PubMed1997

Candidal meningitis in HIV-infected patients: analysis of 14 cases.

Five cases of candidal meningitis in human immunodeficiency virus (HIV)-infected patients have been diagnosed in our hospital. This article describes these cases and reviews another nine previously reported in the literature. Most patients (71%) had at least one well-known predisposing factor for candidiasis. Median CD4 cell count was 135/mm3. Headache and fever, in the absence of focal neurologic signs, were the predominant clinical features. The CSF analysis revealed mild pleocytosis and hypoglycorrachia, indistinguishable from those seen in tuberculous or cryptococcal meningitis. Twelve patients (92%) received amphotericin B for a median of 51 days, in combination with flucytosine in five cases. The overall mortality among treated patients was 31%. Although the risk of relapse of candidal meningitis is unknown, maintenance antifungal therapy was given to seven patients (63%), usually with fluconazole. Candida species must be kept in mind as a cause of chronic meningitis in HIV-infected patients who have a known predisposing factor.

AIDS-Related Opportunistic Infections↗
PubMed1997

[Changes in the concentrations of catecholamines and cortisol in balanced anesthesia and total intravenous anesthesia].

OBJECTIVE: To compare hormone response to stress caused by surgery performed under balanced general anesthesia and total intravenous anesthesia. PATIENTS AND METHOD: Two randomly formed groups of 24 patients each were studied. All patients were scheduled for lumbar laminectomy to correct disc hernias, with one group receiving balanced anesthesia with isoflurane (expiratory fraction between 0.5% and 0.6%), and the second group receiving total intravenous anesthesia (TIVA) (propofol infusion changed every 10 min from 12 to 6 mg/kg/h). Analgesics and relaxants were given by continuous infusion at preestablished doses (fentanyl 2 micrograms/kg/h; vecuronium 0.05 mg/kg/h). Cortisol and catecholamine (adrenalin, noradrenaline and dopamine) levels were determined at the following times: the morning of surgery (baseline), 5 min after intubation, 5 min after incision, 30 and 60 min after intubation; 5 min after tube removal and upon admission to the recovery unit. RESULTS: Cortisol levels decreased from baseline (14 +/- 3 pg/ml) until 30 min after intubation (4 +/- 2 pg/ml; p < 0.05) in the balanced anesthesia group. Adrenaline levels followed the same pattern (baseline 77 +/- 7 versus 57 +/- 10 pg/ml 30 min after intubation). Dopamine levels were statistically different (p < 0.05) at baseline (42 +/- 3 pg/ml), after intubation (38 +/- 2 pg/ml) and after incision (35 +/- 3 pg/ml), but the difference disappeared 30 minutes after intubation (38 +/- 8 pg/ml). Noradrenaline levels after incision (425 +/- 116 pg/ml) were significantly different from those at baseline (671 +/- 124 pg/ml), and the difference was evident until 60 min after incision. In the TIVA group we found significantly higher cortisol levels after intubation (21 +/- 0 pg/ml) than after baseline (14 +/- 2 pg/ml); this level decreased after extubation (7 +/- 0 pg/ml; p < 0.05). Adrenaline levels were significantly higher than at baseline (64 +/- 11 pg/ml) at times corresponding to intubation (76 +/- 5 pg/ml) and extubation (48 +/- 5 pg/ml). Noradrenaline increased significantly over baseline (497 +/- 99 pg/ml) after incision (597 +/- 90 pg/ml) and decreased significantly after 30 min. The increases in cortisol were significantly greater in the TIVA group than in the control group after intubation (21 +/- 0 versus 8 +/- 3 pg/ml, respectively) after intubation, after incision (18 +/- 2 versus 6 +/- 3 pg/ml) and 30 minutes after intubation (15 +/- 2 versus 4 +/- 2 pg/ml). Similar differences were found for dopamine after intubation (49 +/- 2 versus 38 +/- 2 pg/ml) and after incision (45 +/- 5 versus 35 +/- 3 pg/ml). CONCLUSIONS: Hormone levels are significantly higher during intravenous anesthesia than during balanced anesthesia, and the difference is evident from the earliest measurement performed.

Adult↗
PubMed1996

Correlation between in vitro resistance to fluconazole and clinical outcome of oropharyngeal candidiasis in HIV-infected patients.

Fifty episodes of oropharyngeal candidiasis in HIV-infected patients were analyzed prospectively in order to evaluate the clinical response to fluconazole. The minimum inhibitory concentrations (MICs) of fluconazole for the Candida strains isolated from the pharynx were correlated with the clinical response. Treatment with fluconazole (100 mg/day) was successful in 86% of the cases. A good clinical outcome followed in 97% of the cases when a strain sensitive to fluconazole was isolated. This figure fell to 22% when the strain was resistant to fluconazole (p < 0.001). The rate of post-treatment colonization was high (87%), and selection of non-albicans Candida species occurred in 23% of the cases. In conclusion, fluconazole treatment for oropharyngeal candidiasis of HIV-infected patients was useful in most cases, but less sensitive non-albicans species can be selected. Most treatment failures were associated with increased MICs of fluconazole for the strains isolated before treatment; therefore, susceptibility testing is recommended as an aid in clinical decision-making for the use of the azole group of drugs.

Antifungal Agents↗
PubMed1996

Central venous catheter infections in AIDS patients receiving daily home therapy for cytomegalovirus disease.

We studied the infection rate of long-term intravenous access used for daily home treatment of cytomegalovirus (CMV) disease in 61 AIDS patients who had 75 central venous catheters implanted for antiviral maintenance therapy between February 1989 and December 1994. In 39 patients (64%) the risk factor for AIDS was intravenous drug abuse. Sixty-three catheters were Hickman type and 12 were totally implanted ports. The cumulative follow-up time was 19000 catheter-days (52 patient-years), with median duration of placement of 249 days. The infection rate was 0.22 infections per 100 catheter days. The probability of remaining free of catheter-related sepsis was 58% at 6 months. In 25 cases (61%) antimicrobial therapy without catheter removal was successful. Three patients died because of a catheter-related infection (mortality rate 7.3%). Infection-free survival time was not related to the risk factor for AIDS (p = 0.44) or type of device (p = 0.41). The total infection rate in these patients receiving daily home maintenance therapy for CMV disease through a long-term catheter was similar to that in other AIDS patients receiving weekly treatment in hospital facilities.

Acquired Immunodeficiency Syndrome↗
PubMed1996

[Seroepidemiology of hepatitis A virus infection in medical and nursing students. The role of vaccination].

BACKGROUND: Recent seroepidemiologic studies have demonstrated a decrease in the prevalence of hepatitis A virus infection (HAV) in relation with an improvement in hygienic conditions. The prevalence of anti-HAV in a group of health care students was studied and a vaccination program initiated in this collective. METHODS: Serum anti-HAV determination was performed by an enzymoimmunoanalysis method. A inactivated hepatitis A vaccine was administered. RESULTS: Only 18.5% of the subjects between 17-23 years-old presented anti-HAV antibodies. The prevalence of anti-HAV was related with age and the number of partners. All of the 129 immunized individuals responded to the HAV vaccine with protector antibody titles. CONCLUSION: The present study demonstrates the decrease in HAV infection among youths as well as the immunogenicity of the anti-hepatitis A vaccine.

Adolescent↗
PubMed1996

[Utilization of a post-anesthetic recovery index].

OBJECTIVES: 1. To introduce use of the postanesthesia recovery score (assessing consciousness, mobility, ventilation, hemodynamics and blood analysis) as a good method for evaluating and classifying recovery from anesthesia in the postoperative care unit. 2. To determine overall patient progress and assess the influence of various patient, anesthetic and surgical factors. PATIENTS AND METHODS: This was a multicenter study of 1,227 patients. We excluded all patients who were to be transferred to intensive care units after surgery. A score of 10 or more, with no single item score equal to 0, was considered optimal for discharge from the postanesthesia care unit. RESULTS: The lowest score upon admission to the unit was among patients who had undergone high abdominal surgery (16.4%). Scores over 9 belonged to patients who had undergone lower abdominal and perineal surgery (87.5 and 95.3%, respectively). Scores were < or = 9 in patients who received inhaled anesthetics (42%). Intravenous anesthesia patients (84.4%) had scores over 9. The local-regional anesthetic procedures with the best scores were axilar blocks and local infiltrations. Patients staying longer in the recovery unit were those classified as ASA III, those whose procedures lasted longer than 120 minutes, those undergoing surgery on the upper abdomen or on extremities, those receiving isoflurane and pancuronium, and those suffering adverse events during and after the procedure. Factors influencing perioperative events were age, duration of procedure and history of intraoperative events.

Adolescent↗
PubMed1995

[The efficacy of the prevaccination detection of anti-HAV in hepatitis A vaccination programs].

BACKGROUND: The convenience of carrying out prevaccination detection studies of hepatitis A virus (HAV) markers depends on the relative costs of the detection and vaccination, as well as the prevalence of susceptible subjects in each population group to be vaccinated. The aim of this study was to analyze the efficacy of the systematic prevaccination detection of anti-HAV antibodies in Catalonia, Spain. METHODS: The following formula was applied: Unit cost of detection + (1-X) x Unit cost of vaccination of anti-HAV negative subjects = group vaccination cost, with X being the threshold of prevalence of marker under which detection no longer remains efficient. This prevalence was compared with the findings of a seroepidemiologic survey carried out in international travellers and food handlers. RESULTS: The unit cost of the detection of anti-HAV was calculated as 2,733 pesetas, and the unit cost of the vaccination as 9,963 pesetas obtaining a prevalence anti-HAV threshold of 27%. This prevalence corresponds to travellers under the age of 30 years and food handlers under the age of 25 years. CONCLUSIONS: The systematic detection of anti-HAV is only recommended in population groups in which prevalences higher than 27% may be expected. The vaccination is more efficient without a previous marker study under this threshold. According to this study, direct vaccination of food handlers under the age of 25 years (born after 1969) is recommended as is that of international travellers under the age of 30 years (born after 1964). In those over the age of these collectives, the prevaccination study is more efficient.

Adolescent↗
PubMed1995

[Cost-effectiveness of the methods of smoking cessation].

BACKGROUND: The cost-effectiveness of the following methods of cessation of smoking were calculated in this study: 1) medical advice, 2) medical advice and nicotine chiclets, and 3) medical advice and nicotine patches. METHODS: The costs and effectiveness of the methods of cessation of smoking compared in terms of cost per year of life gained, deducing the costs and benefits at 5%. RESULTS: The cost per year of life gained was found to be 260,000 to 434,000 pesetas in males and 441,000 to 637,000 in women for medical advice, 287,000 to 479,000 in males and 486,000 to 703,000 in females for advice and nicotine chiclets and 329,000 to 549,000 in males and 557,000 to 805,000 in females for advice and nicotine patches. Maximum efficacy was achieved with the three methods in the age group from 45-59 years in males and from 50-54 years in females. On comparison of cost and effectiveness of the methods of nicotine substitution with those calculated for medical advice the increase in cost-effectiveness was shown to be 395,000 to 658,000 in males and 668,000 to 966,000 in females for advice and chiclets and from 467,000 to 779,000 in males and 791,000 to 1,142,000 in females for advice and patches. The increase in cost-effectiveness for advice and patches versus advice and chiclets was from 539,000 to 899,000 in males and 913,000 to 1,318,000 in females. CONCLUSIONS: The efficiency of achieving the cessation of smoking is very similar for medical advice and medical advice plus nicotine chiclets and is somewhat less for medical advice and nicotine patches. The results of this study place the methods of smoking cessation among the most effective health care procedures.

Adult↗
PubMed1995

Cost-effectiveness analysis of hepatitis B vaccination strategies in Catalonia, Spain.

Hepatitis B virus (HBV) infection is an important public health problem all over the world. Vaccination is one way to prevent it, and several strategies can be used depending on endemicity, the main pattern of HBV transmission and the demographic structure of the population. In this study, an economic comparison of 3 vaccination strategies (mass adolescent vaccination, mass infant vaccination and mass combined vaccination) was performed in Catalonia, Spain. Screening pregnant women for HBV infection in combination with these strategies was also evaluated. Epidemiological models to analyse patterns of HBV infection with and without vaccination and to calculate HBV-associated costs were designed. Comparison between strategies was done using cost-effectiveness analysis from the perspective of the healthcare system. Epidemiological model results indicate that implementation of HBV vaccination could prevent as many as 104,778 new acute infections, and avoid up to 5239 chronic infections, 2096 cases of cirrhosis and 419 cases of hepatocarcinoma over a 20-year period in Catalonia. Cost-effectiveness analysis shows that mass adolescent vaccination is the most efficient strategy, with lower costs per avoided case than the other 2 strategies. When any of these strategies is complemented by screening for HBV in pregnant women, the number of avoided cases is always higher and the cost per avoided case decreases or remains unchanged.

Adolescent↗
PubMed1995

[Adrenergic response during general anesthesia with propofol as maintenance agent].

To determine plasma catecholamine levels during the use of propofol for maintenance of anesthesia. We studied 20 randomly chosen patients undergoing elective orthopedic surgery under general intravenous anesthesia with propofol as the agent of maintenance along with pancuronium and fentanyl. Plasma concentrations of dopamine, noradrenalin and adrenalin were measured at the following times: baseline, after intubation and every 15 min during surgery. The levels obtained for the different samples were compared with baseline levels. At the doses used in our study, there were no significant differences in the way dopamine plasma levels varied. This was not the case with the other two hormones, however. Adrenalin levels were significantly higher at the first 3 extractions (post-intubation, 15 min and 30 min), and noradrenalin was significantly higher (p < 0.05) at all extraction times. Total intravenous anesthesia with propofol is associated with a significant increase in plasma concentrations of adrenalin and noradrenalin. Adrenalin returns to baseline levels 45 min after induction.

Adult↗
PubMed1994

[Seroepidemiology of hepatitis C virus infection in pregnant women in Catalonia].

BACKGROUND: The aim of this study was to investigate the prevalence of hepatitis C virus (HCV) infection in a population of pregnant women in Catalonia and the sociodemographic variables and risk factors associated to this prevalence. METHODS: A representative sample of the pregnant women in Catalonia (n = 4,551) randomly selected by clusters (hospitals with maternity clinics) was studied. Detection of antiHCV antibodies was performed by the third generation ELISA test. Reactive cases were confirmed with RIBA 3 and MATRIX. RESULTS: The prevalence of antiHCV was found to be 1% and was not significantly associated with any of the sociodemographic variables studied (age, social and cultural level, origin and residence). A history of blood transfusion, intravenous drug consumption and hepatitis in the sexual partner were the only risk factors associated with the prevalence of infection found on univariate analysis although these were only present in 47% of the antiHCV positive cases detected. The association between the positivity of antiHCV and the history of hepatitis in the partner was lost on stratification of the cases according to the possible existence of history of drug addiction. CONCLUSIONS: A high proportion of young asymptomatic people (1%) were found to have hepatitis C virus infection with the possible mode of infection not being detected in approximately half of these subjects. In the other half of these cases the infection was found to have been acquired by an intravenous mechanism: blood transfusion or drug use.

Adult↗