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E Navas

Publications and source records attributed to E Navas.

At least 73 records · Page 4Linked to original sources
PubMed1994

[Tuberculous meningitis caused by resistant microorganisms. Therapeuticfailure in 2 patients with HIV infection and disseminated tuberculosis].

BACKGROUND: Tuberculosis in HIV infected patients does not carry a worse therapeutic response rate. Treatment failure is usually due to incomplete schedule, with development of acquired resistance. Two patients with HIV infection and disseminated tuberculosis who developed fatal meningitis are presented. METHODS: In vitro studies of sensitivity to anti-tuberculous drugs were carried out, using the proportions method. RESULTS: Following a good initial evolution, both patients were readmitted with tuberculous meningitis resistant to isoniazide in both and to rifampicin in one of the patients. In one patient, the original strain (which was sensitive) was available. In this patient, changes in the treatment were performed in the initial phase. CONCLUSIONS: The importance of anti-tuberculous multiple therapy, particularly in the initial phases, for HIV positive patients is crucial. The lengthen of admission when good patient's compliance is in question, but also to avoid, whenever possible, changes in treatment are important measures in this stage. Meningitis may occur as a form of therapeutic failure and its cure may be difficult if the strains are resistant.

AIDS-Related Opportunistic Infections↗
PubMed1994

Native valve endocarditis due to Candida parapsilosis: a late complication after bone marrow transplantation-related fungemia.

A case of Candida parapsilosis endocarditis observed 16 months after BMT is reported. The patient, a 35-year-old female with CML, suffered from Candida parapsilosis fungemia on day +22 after BMT. In spite of treatment with amphotericin B, fluconazole and catheter withdrawal, the same yeast was isolated > 1 year later from a vegetation on an old rheumatic mitral valve. Although the patient remained in complete cytogenetical and hematological remission, in vitro tests showed reduced phagocytic and chemotactic capacity of neutrophils and monocytes. This case stresses the need of prolonged therapy for patients with candidemia after BMT.

Adult↗
PubMed1993

Faster isolation of Brucella spp. from blood by isolator compared with BACTEC NR.

Brucella spp. was isolated from blood cultures in a mean time of 3.1 days (range, 2-5) in seven cases of human brucellosis processed with the Isolator lysis-centrifugation system. Simultaneous BACTEC NR blood cultures in the same patients were positive in six, with a mean detection time of 20.6 days (range, 17-29). These data suggest a higher speed of recovery of Brucella spp. from blood specimens with the lysis-centrifugation procedure compared with the BACTEC NR system.

Bacteriological Techniques↗
PubMed1993

[Roxithromycin in the treatment of community-acquired pneumonia].

BACKGROUND: The aim of the present study was to prospectively evaluate the efficacy and tolerance of roxithromycin in the empiric treatment of extra-hospitalary pneumonias in immunocompetent adult patients. METHODS: Over a 12 month period 101 patients with extra-hospitalary pneumonia who attended the Emergency Department were studied. Of these, 53 were treated as out patients (5 with amoxicillin-clavulanic, 25 with erythromycin and 23 with roxithromycin at daily doses of 300 mg for 10 days). The treatment was randomly chosen, with no patient selection, thus making heterogeneous groups and, therefore, the study could not be comparative. RESULTS: In patients receiving roxithromycin, an etiologic diagnosis was achieved in 15 cases (65.3%), with Mycoplasma pneumoniae, being the most frequent pathogen (10 cases), followed by Streptococcus pneumoniae (3), Chlamydia pneumoniae (1) and Haemophilus influenzae (1). The mean duration of fever was 1.9 days, 6.7 days for respiratory manifestations and resolution of the radiographic infiltrate 11.6 days. The evolution was good in all the patients with no secondary effects or relapse occurring in any patient. CONCLUSION: Roxithromycin is an effective, safe and comfortable antibiotic in the treatment of infections of the lower respiratory tract acquired in the community.

Adolescent↗
PubMed1992

[Efficiency of prevaccination screening of anti-HBc in the anti-hepatitis B vaccination programs].

BACKGROUND: The convenience of carrying out pre-vaccination screening of VHB markers depends on the relative costs of screening and vaccination and also on the prevalence of susceptible subjects in each group of the population. The aim of the present work was to analyse the efficiency of pre-vaccination screening of antiHBc in Catalonia in 1991. METHODS: The per-unit cost of screening was calculated at 1366 ptas. The formula applied was: cost per-unit of screening + (1-X) x the cost per-unit of vaccination of anti-HBc (-) = cost of vaccinating the group. "X" being the threshold of prevalence of markers below which screening cases to be efficient. This prevalence is compared with those expected in the groups of the population to be vaccinated. RESULTS: By applying the above-mention ned formula and taking into account costs in time and travel of the people to be vaccinated, a prevalence threshold of 23% is obtained. This prevalence is much higher than that found in adolescents and students of medicine and nursing, similar to that found in health professionals and lower than that of other risk groups. CONCLUSIONS: Systematic screening of anti-HBc is only recommended in groups of the population where a prevalence higher than 20-25% can be expected. Below this threshold vaccination without previous study of markers is more efficient. This enormously simplifies the strategies of universal vaccination of children, adolescents or both.

Carrier State↗
PubMed1992

Pneumocystis carinii pneumonia in HIV-infected patients: diagnostic yield of induced sputum and immunofluorescent stain with monoclonal antibodies.

The purpose of this study was to evaluate the diagnostic yield of induced sputum (IS), assessing the reliability of indirect immunofluorescent stain with monoclonal antibodies (IFMoAb) and methenamine silver (Met-Ag) and analysing factors likely to influence the sensitivity of these techniques. An analysis was prospectively carried out on IS specimens collected from 61 human immunodeficiency virus (HIV)-infected patients during 69 episodes of suspected Pneumocystis carinii pneumonia. Ultrasonic nebulizers with hypertonic 2% saline were used. IFMoAb to P. carinii and Met-Ag were performed after cytocentrifugation of the specimen. Results were compared with those of bronchoalveolar lavage (BAL) with/without transbronchial biopsy (TBB), performed not more than seven days after induction of sputum. P. carinii pneumonia was confirmed in 32 episodes, of which IS was diagnostic in 23. The sensitivity of the staining procedures was 69% for IFMoAb, and 28% for Met-Ag. The three episodes of P. carinii pneumonia in patients on oral chemoprophylaxis yielded negative IS results; in contrast, IS was negative in only 6 of the 29 cases not receiving chemoprophylaxis. IS is a non-aggressive procedure that diagnosed P. carinii pneumonia in 72% of our cases. The yield increased significantly when IFMoAb was used in patients not receiving oral chemoprophylaxis.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Cryptococcosis not associated with AIDS. Clinical study of seven patients].

BACKGROUND: The aim of the present was to study the clinical characteristics, the diagnostic methods, response to treatment and the evolution of cryptococcosis not associated with AIDS. METHODS: Seven cases studied in the Hospital Ramon y Cajal of Madrid, Spain over a 19-year period (1980-1998). Diagnosis was determined by LCR culture, blood or other clinical samples. RESULTS: Four patients were males with a mean age of 45.1 years (range: 23-69 years). All except one case presented a predisposing disease and three received corticoids and/or immunosuppressive drugs. Six patients presented meningitis and one pneumonia. The meningitis showed a subacute course with pleocytosis, hypoglycorrhachia and hyperproteinorrhachia in most of the patients. Chinese ink staining, culture and the cryptococcic antigen of LCR were positive in all the cases of meningitis evaluated. All the patients were initially treated with amphotericin and fluorocytosin. This schedule was substituted in two cases by amphotericin lipid formulas because of adverse effects and by fluconazol as an elective choice in one case. The evaluation was favorable in all the patients. One patient presented meningeal and cutaneous recurrence. Three patients died, although none did so during the acute episode or as a consequence of the infection. CONCLUSIONS: Cryptococcosis not associated with AIDS is rare in Sapin. It usually evolves with subacute hypoglucorrhachic meningitis and the conventional diagnostic techniques (Chinese ink staining, cryptococcic antigen and culture) provide adequate profitability. Response to treatment with amphotericin and fluorocytosis is usually favorable, although there are therapeutic alternatives which are adequate for selected cases.

Adult↗
PubMedDate not supplied

[Utility of premedication with different regimens of omeprazole and ranitidine in the prevention of acid broncho-aspiration syndrome].

OBJECTIVE: To study the usefulness of several omeprazole regimens on gastric fluid volume and pH in patients undergoing elective surgery. MATERIAL AND METHODS: We analyzed 105 patients undergoing to elective surgery who received prophylactic treatment for the acid aspiration syndrome. They were randomly allocated into 7 homogeneous groups according to the therapeutic regime. Placebo (group 1), oral omeprazole (20 mg) the night prior to surgery (group 2), oral ranitidine (150 mg) the night before (group 6), two doses (the previous night and before surgery) in the remaining three groups: 20 mg of omeprazole (group 4), 40 mg of omeprazole (group 5) or 150 mg of ranitidine (group 7). In all patients we measured pH and volume of the gastric content after induction of anesthesia and one hour thereafter. RESULTS: There were no statistically significant differences in mean pH values and gastric volume content among groups 1.2,3, and 6 (2.1 (pH) and 27 ml (gastric volume) in group 1, 2.1 and 23 ml in group 2, 2.6 and 19 ml in group 3, and 2.2 and 32 ml in group 6). With repeated doses of 40 mg omeprazol (group 5), mean pH values were comparable to those found with the two doses of ranitidine (4.1 +/- 1.8 vs 4.1 +/- 3.6) although gastric volumes were significantly less (12 +/- 2.6 ml vs 20 +/- 4.8 ml). These two groups showed significantly greater mean pH values and less gastric volumes than the remaining patients. CONCLUSIONS: The incidence of patients with gastric content deemed at risk for acid aspiration (pH less than 2.5 and gastric volume greater than 25 ml) was less after premedication with two oral doses of omeprazole (40 mg) than either two doses of ranitidine (150 mg) or smaller doses of both drugs.

Adult↗
PubMedDate not supplied

[Prophylaxis with dantrolene sodium in 2 patients with susceptibility to malignant hyperthermia].

We report 2 patients programmed for elective surgery who were considered susceptible to develop the malignant hyperthermia syndrome. The first patient had two familiarly antecedents of death produced by postanesthetic malignant hyperthermia, whereas the second patient suffered a clinical picture compatible with this syndrome during tonsillectomy, although followed a favourable recovery. The preoperative study including measurement of muscular enzymes, isoenzymes, and muscular biopsy was normal. In both patients an intravenous prophylactic treatment with dantrolene 2.5 mg.kg1 was undertaken before surgery. The first patient underwent hysterectomy under intradural anesthesia with bupivacaine 0.5%. The second patient had a maxillary fracture which was treated with osteosynthesis under general anesthesia. During the intervention and the postoperative follow-up, both patients were free of signs related to malignant hyperthermia. We conclude that prophylaxis with dantrolene is necessary in patients susceptible to develop the syndrome of malignant hyperthermia.

Adult↗
PubMedDate not supplied

[Nosocomial varicella: study of an epidemic outbreak among immunosuppressed patients].

We describe the guidelines used and the clinical and epidemiological data of a varicella outbreak seen in our service. The index case was a male drug addict, seropositive for HIV, with disseminated varicella. A total of 40 health care workers were in contact with the patient. Of them, 37 were considered not to be susceptible of having the disease. The remaining three health care workers developed varicella, and one had been also in contact with other hospitalized patients during the exposure period. Serological test for varicella (FAMA) of all 20 exposed patients (all HIV positive) showed that only four were susceptible. Those were put on isolation and immunoglobulin against zoster-varicella (VZIG) was used. Only one developed varicella. We recommend: a) the index case has to bep put under strict isolation precautions or discharged; b) acyclovir should be given to all immunosuppressed patients; c) immunoglobulin (VZIG) should be used in immunosuppressed patients susceptible to varicella and exposed to index case, and d) live, attenuated vaccine should be used in non immunosuppressed susceptible patients.

Acquired Immunodeficiency Syndrome↗