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F Parras

Publications and source records attributed to F Parras.

49 records · Page 3Linked to original sources
PubMedDate not supplied

Non-typhi Salmonella bacteraemia.

We reviewed retrospectively the clinical records of patients with non-typhi Salmonella bacteraemia in our hospital from 1979 to 1988. During the study period 45 non-typhi Salmonella bacteraemias were diagnosed in 43 patients. Ten patients were under one year old and 11 were over 60. Seven cases of sepsis presented in patients with AIDS. Only three episodes were nosocomially acquired. In two of three patients the bacteraemia was preceded by an episode of acute gastroenteritis and one third presented without gastroenteritis. Complications and mortality were infrequent in spite of the differing degrees of adequacy of antibiotic treatment which was inappropriate in many cases. We have attempted to assess optimal antibiotic therapy, taking into account the duration and means of administration, in different groups of patients with nontyphi Salmonella bacteraemia.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Brucellar meningitis.

Neurobrucellosis develops in less than 5% of cases of systemic brucellosis; however, most patients with neurobrucellosis have meningeal involvement. Seven new cases of brucellar meningitis and 17 cases from the Spanish- and English-language medical literature are analyzed in terms of epidemiologic data, clinical manifestations, laboratory results for cerebrospinal fluid and serum, treatment, and course of the disease. Brucellar meningitis mimics other neurologic and non-neurologic conditions, and its diagnosis is only suggested in the presence of adequate epidemiologic information. Isolation of Brucella from the cerebrospinal fluid is uncommon. Treatment is accomplished with the combination of tetracycline or doxycycline and streptomycin, rifampin, or both. Mean length of therapy in the seven new cases was 8.5 months. Brucellar meningitis has a better prognosis than other forms of chronic meningitis, and mortality is low for reasons that are not clear; however, the incidence of minor sequelae is high.

Adolescent↗
PubMedDate not supplied

[Recommendation of GESIDA (AIDS Study Group)/National Plan on AIDS with respect to the anti-retroviral treatment in adult patients infected with the human immunodeficiency virus in the year 2000 (I)].

OBJECTIVE: To update the recommendations for antiretroviral therapy in adult HIV-infected persons according to the new scientific advances and the existence of new antiretroviral drugs in the last two years. METHODS: The antiretroviral therapy recommendations have been condensed by a panel of experts from the Spanish AIDS Study Group (Grupo de Estudio de sida-GESIDA) of the Spanish Infectious Diseases and Clinical Microbiology Society (SEIMC) and from the Clinical Advisory Panel of the Secretariat of the Spanish National Plan on AIDS (SPNS) of the Ministry of Health. Three levels of evidence have been established depending if the data came from randomised and controlled studies, from cohort or case-control studies or from descriptive studies and expert opinions. For that purpose we have reviewed the advances in HIV pathophysiology and results of efficacy (clinical, virologic and immunologic) and security (toxicity) from clinical trials involving antiretroviral therapy lasting at least 12 months, from cohort studies and pharmacokinetic and security data of antiretroviral drugs, presented in international conferences or published in biomedical journals in the last two years. In each situation we have established either to recommend or to consider or not recommend antiretroviral therapy. RESULTS: Nowadays, antiretroviral therapy consisting of at least three drugs constitutes the election therapy for chronic HIV infection, since it delays clinical progression, increases significantly the survival and diminishes hospital admissions and associated costs. The decision to start antiretroviral therapy must be based upon three elements: presence or absence of symptoms, plasma viral load and CD4+ cells counts. Thus, in asymptomatic cases with a high CD4+ cells count (> 500/microL) and low viral load (< 10,000 copies/ml by branched DNA [bDNA] or < 20,000 copies/ml by reverse-transcription polymerase chain reaction [RT-PCR] or nucleic acid sequence based amplification [NASBA]) we recommend to delay antiretroviral therapy. In symptomatic patients we recommend to start it, and in asymptomatic patients, we could recommend or consider antiretroviral therapy initiation depending on the risk of progression, established by the viral load and the CD4+ cells count. In any case, if therapy is started, the objective must be to reach an undetectable viral load (< 50 copies/ml). The adherence to antiretroviral therapy plays a key role for its initial moment and for the duration of the antiviral response, antiretroviral therapy can achieve a restoration of cellular immunity in the advanced patients. There are few therapeutic options in failing patients due to cross-resistance. Resistance studies can be useful in this setting. The toxicity is a new and limiting factor of antiretroviral therapy which requires to look for new therapeutic options. Antiretroviral therapy criteria for acute infection, pregnancy, post-exposure prophylaxis and when to use resistance testing are discussed. CONCLUSIONS: In this moment, there is a more conservative attitude towards starting antiretroviral therapy than in previous recommendations in which a virus eradication was considered. On the other hand, the high number of disposable drugs, the more sensitive monitorization methods (plasma viral load) and the possibility of performing resistance studies make therapeutic strategies more dynamic and individualised for each patient and situation. In any case, it is mandatory to ensure a perfect adherence to antiretroviral therapy from the patients.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Neutropenia secondary to cefotaxime use].

Agranulocytosis is an uncommon complication of beta-lactam antibiotic therapy. Two patients who developed absolute neutropenia and anemia after having received 168 g of cefotaxime are reported. There was fever and rash, and hematologic recovery too place 10 and 6 days after withdrawal of the drug. The bone marrow culture showed that the incubation of cells with cefotaxime (10 micrograms/ml) induced a 26 +/- 1% inhibition of the formation of granulocytic colonies (CFU-GM) in controls and a 47% and 48% inhibition, respectively, in the two patients with neutropenia. When serum was added to the culture, the control serum improved the in vitro granulopoietic response, while the serum from the first patient inhibited in 77 +/- 1.5% the formation of CFU-CM in the control marrow. The need for the monitoring of peripheral blood cells in patients receiving long term treatment with beta-lactam antibiotics emphasized, as we have shown the suppressor effect of cefotaxime on the hematopoietic precursors and the effect of an autoimmune mechanism in some cases.

Aged↗