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F J Guerrero

Publications and source records attributed to F J Guerrero.

11 recordsLinked to original sources
PubMed2002

[Diagnosis and treatment of refractory sprue].

Celiac disease is a gluten-sensitive enteropathy characterized by villous atrophy that is reversed by gluten withdrawal. A minority of these patients is resistant to a gluten-free diet or, after a period of remission, they experience relapse despite continued adherence to treatment, which is called unclassified sprue or refractory sprue.The prognosis of refractory sprue may be poor: patients may die of severe malabsorption or from the development of an enteropathy-associated T-cell lymphoma. We report a 72-year-old-woman with a diagnosis of refractory sprue who responded well to treatment with corticosteroids and a gluten-free diet.

Aged↗
PubMed2000

[Serologic response against hepatitis C virus as a predictive factor to the treatment with interferon].

AIM: Serologic response of patients with chronic hepatitis C (CHC) was studied as a predictor of response to IFN therapy and we evaluated the correlation between such response with gender, risk factor, serum ferritin, GGT, Knodell's index and fibrosis. MATERIALS AND METHODS: A study was carried out in 40 patients with CHC who were treated with interferon-alpha 3 MU 3 times weekly 48 weeks. The diagnosis of hepatitis C was made based upon Inmuno-Blot (core, NS3, NS4 y NS5) and confirmed by detection of HCV-RNA in serum. Responses were evaluated (normal ALT and undetectable HCV-RNA in serum) at three months, at the end of treatment and six months after treatment. RESULTS: No significant differences were observed in responses at three months with regard to gender (47% males responded versus 55% females, n.s.), source of infection (50% intravenous drug users versus 50% non intravenous drug users; n.s.) and GGT level (50% with high levels versus 50% with normal levels, n.s.); however 25% of patients with high level of serum iron responded versus 59% with normal values (p = 0.04) and 28% of patients with fibrosis at liver histopathology responded versus 82% without fibrosis (p = 0.0006). No differences were observed at the response rates with regard to levels of core (20.1 SD:4 versus 19.5 SD:2.2, n.s.), NS3 (18.6 SD:7 versus 17.1 SD:7.3, n.s.) and NS4 (14.3 SD:7.7 versus 10.5 SD:9.2, n.s.). However NS5 levels in responders were 2.5 (0-16) versus 5.2 (0-16.5) in nonresponders (p < 0.05) and score in Knodell's index was 6.1 SD:2.6 in responders versus 9.2 SD:2.4 in nonresponders (p = 0.006). 47% of responders relapsed 6 months after the end of treatment with IFN. CONCLUSIONS: Titers of anti-NS5 showed predictive value of response as opposed to anti-core, anti-NS3 and anti-NS4 and it may justify its determination in the assessment of a patient with CHC at centers without capacity for measuring genotype and viral load. Low level of serum iron and Knodell's index like absence of fibrosis at liver histopathology were also variables with predictive value of response, as opposed to gender, GGT level and source of infection.

Adolescent↗
PubMed1999

Parenteral infusions bacterial contamination in a multi-institutional survey in Mexico: considerations for nosocomial mortality.

BACKGROUND: Parenteral infusions can be contaminated during administration (extrinsic contamination). A previous survey found that extrinsic contamination was not uncommon in a hospital in Mexico with lapses in aseptic techniques. To determine whether this problem exists in other similar institutions, we undertook a multi-institutional study. METHODS: We surveyed 6 hospitals (A to F) lacking an infection control committee to determine the level of extrinsic contamination. We visited each hospital and obtained samples of all the parenteral infusions in use, drawing 0.5-1 mL from the tubing injection port. Quantitative and qualitative bacterial cultures were performed. Chlorine levels of the tap water were measured. Visits were repeated until the survey was completed. RESULTS: A total of 751 infusions were cultured, of which 16 (2.13%) were contaminated. Hospital contamination rates varied from zero to 5.56%. Klebsiella pneumoniae was the most common isolate (10 cases). During the first sampling day in hospital C, the 7 infusions from the pediatric ward were found to be contaminated with a similar K pneumoniae strain. In-service education was started in this hospital. Infusion contamination was eliminated followed by a reduction in mortality rate. Overall, a higher risk for infusion contamination was noted for pediatric patients (P =.01, odds ratio = 3.28, 95% CI, 1.10-9.91) and in wards with inadequate water chlorine levels (P =. 02, odds ratio = 3.64, 95% CI, 1.08-13.51). CONCLUSIONS: If the hospitals surveyed are representative of others in developing countries, an endemic level of parenteral infusion contamination could exist in many hospitals throughout the world.

Adult↗
PubMed1999

[The epidemiology of Q fever in the northern area of Huelva, Spain].

OBJECTIVE: The aim of the present study is to know the prevalence, incidence and clinical presentation of the acute Q fever in the north of the Huelva district. METHODOLOGY: a) Prevalence: 1,654 serum were randomly collected from the health district and distributed by their origin, age and sex. The methodology used was the indirect immunofluorescence, Coxiella burnetii phase II as antigen. Were regarded as positives those serum whose titles were equal or higher to 80; b) Incidence: prospective study of every case treated in hospital during 1996-1997 plus every referred patient from the different "Health Centers". An acute case of Q fever was established as a feverish syndrome of more than 2 days plus a title equal or higher to 320 against C. burnetti phase II antigen, and c) Clinical data: all the patients were clerked and similar form was filled up including the following items: pneumonia, hepatitis, headache, persistent fever, etc. RESULTS: a) Prevalence: it was 5.08%, more frequent in men than in women; b) Incidence: 21 new cases over two years, an incidence of 12.70 cases per 100,000 population, and c) CLINICAL PRESENTATION: feverish syndrome plus hepatitis in 100% of the cases, just two pneumonia were recorded and in 4 cases the clinical picture was associated to immunological symptoms with persistent fever. CONCLUSION: A discrepancy between incidence and prevalence has been pointed out which makes us think that the majority of the Q fever cases in this area debut as a self restricted feverish syndrome which does not require specialized treatment.

Adolescent↗
PubMed1999

[Control of pediatric nosocomial bacteremia by a program based on culturing of parenteral solutions in use].

OBJECTIVE: As Klebsiella, Enterobacter and Serratia are capable of growth in i.v. fluids and these bacteria are commonly implicated in nosocomial bacteremia, a control strategy through microbiological surveillance of in-use parenteral solutions is proposed. MATERIAL AND METHODS: A second level general teaching hospital, serving low-income patients. Through four consecutive strategies, a continuous surveillance program of i.v. fluids sterility in pediatric wards was stablished in 1992. During the first stage all of the in-use solutions were cultured. During the second stage randomly selected samples were studied. Third stage was designed as a case-control study. The last stage included samples drawn in convenience. Positive cultures point out eventual infusion mishandling, as well as high-risk areas and patients. RESULTS: After culturing 1940 parenteral solutions, infusion contamination rates decreased from 29.6% in 1992 to 12.9% in 1997 (p < 0.001). The proportion of Gram-negative rods isolated from blood cultures went from 72.7% to 40.85% (p < 0.0001), and the nosocomial bacteremia rate dropped from 3.12 to 1.54 per 100 discharges. CONCLUSIONS: The program has enabled us to: 1) Detect and control eventual bacteremia outbreaks; 2) Assess the endemic infusion contamination rate; 3) Arouse healthcare workers awareness about infusion line precautions; 4) Have a suitable surveillance strategy according to our laboratory's workload.

Bacteremia↗
PubMed1998

[Eradication of Helicobacter pylori by triple therapy in ulcerous patients: the role of endoscopy and antibiotic sensitivity].

BACKGROUND: A protocol was conducted to evaluate the compliance and results of Helicobacter pylori infection treatment in patients with ulcer disease. To know the metronidazole, clarithromycin and amoxicillin activities of Helicobacter pylori strains from such patients. PATIENTS AND METHODS: 35 patients with ulcer disease (27 duodenal ulcer and 8 gastric ulcer) were studied. Diagnosis of Helicobacter pylori infection was performed by urease test and culture of mucosal gastric samples from patients undergoing endoscopy. The patients received the following treatment during 7 days: omeprazole (20 mg bid), clarithromycin (500 mg bid) and amoxicillin (1 g bid), OCA x 7. Susceptibility was determined by E-test system on Wilkins-Chalgren blood agar and read after 5 days. RESULTS: 22/24 patients who had completed the protocol design eradicated Helicobacter pylori (91.7%), 11 patients (31.4%) refused second endoscopy to verify control of eradication. After treatment 10 patients presented with pyrosis "de novo" (28%). The overall metronidazol, claritromycin and amoxicillin resistance rate was 50%, 1.5% and 0% respectively. CONCLUSIONS: OCA x 7 treatment obtains a eradication rate higher than 90% in our patients with ulcer disease, despite smoking habit, but with a significative number of patients presenting pyrosis after treatment. We recommend a non-endoscopy method to verify eradication rate, because of its poor acceptance. 3. Metronidazol resistance rate is high in our series but clarithromycin susceptibility is maintained.

Adult↗
PubMedDate not supplied

Parenteral infusions as culture media from a viewpoint of nosocomial bacteremia.

OBJECTIVE: To assess the growth patterns of selected organisms in common parenteral solutions, in order to ascertain implications for nosocomial bacteremia. DESIGN: A microbial suspension of approximately 300 CFU/mL was sequentially inoculated into common parenteral infusions from three different manufacturers and incubated at room temperature. Initially, 11 bacterial isolates and one Candida species from clinical specimens were studied. Eight gram-negative rods (GNR) were tested at varying pH's. Species variability was examined by testing an additional 39 isolates. RESULTS: The eight GNR grew in Ringer's lactate (RL) from two manufacturers and only two grew in dextrose 5% in water (D5/W) (Klebsiella pneumoniae and Serratia marcescens). No organism grew in saline or dextrose 5% in saline. The gram-positive cocci and Candida did not grow in any solution. No significant changes in growth were found after modifying the pH of solutions. Significant inter- and intra-species growth variability was noted. CONCLUSIONS: RL is a good culture media for GNR and D5/W is a poor culture media with the exception of some bacteria of the Tribe Klebsielleae. We recommend to follow high standards of nursing practice for administering intravenous infusions and to avoid nutrient-containing solutions for prolonged parenteral use, when possible.

Bacteremia↗