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H Correa

Publications and source records attributed to H Correa.

At least 37 records · Page 2Linked to original sources
PubMed1999

Variations in etiology of ventilator-associated pneumonia across four treatment sites: implications for antimicrobial prescribing practices.

This retrospective multicenter study compared microorganisms documented by quantitative cultures from bronchoscopic samples in episodes of ventilator-associated pneumonia (VAP) from three different institutions in Barcelona (B), Montevideo (M), and Seville (S). The observations were compared with the findings reported by Trouillet and coworkers (AJRCCM 1998;157:531-539) in Paris (P). The objective was to evaluate whether a classification of etiologies of VAP in four groups, based on the number of ventilation days and previous antimicrobial use, might contribute to establishing generalized guidelines for empirical therapy. Significant variations in etiologies (p < 0.05) were found in all of the microorganisms isolated from VAP episodes across three treatment sites when compared with the reference site (P). In Group 1 (< 7 d and absence of antibiotics), Pseudomonas aeruginosa remained extremely infrequent (3 of 89, 3.3%) in the joint category, whereas the incidence of Acinetobacter baumannii was significantly higher, owing to M findings. On the other hand, one site (B) had a significantly lower incidence of multiresistant pathogens (Methicillin-resistant Staphylococcus aureus [MRSA] and nonfermenters other than P. aeruginosa), even in Group 2 (< 7 d and antibiotics), Group 3 (>/= 7 d and absence of antibiotics), and Group 4 (antibiotics and >/= 7 days). Similar findings were documented when episodes were grouped according to Groups 1 and 3 of the ATS guidelines. We conclude that causes of VAP varied markedly across four treatment sites, resulting in the need for large-scale variations in antimicrobial prescribing practices. Instead of following general recommendations, antimicrobial prescribing practices for VAP should be based on up-to-date information of the pattern of multiresistant isolates from each institution.

Adult↗
PubMed1997

Risk factors for infection by Acinetobacter baumannii in intubated patients with nosocomial pneumonia.

STUDY OBJECTIVE: To investigate the epidemiology of infection by Acinetobacter baumannii in patients with ventilator-associated pneumonia (VAP). DESIGN: Prospective clinical study. SETTING: Three medical-surgical ICUs in teaching hospitals. PATIENTS: We followed up 707 mechanically ventilated patients and 148 episodes of VAP with etiologic diagnosis. RESULTS: A baumannii was isolated in 12 (8.1%) episodes in 148 patients. Five of these episodes were directly responsible for death. Using logistic regression analysis, the risk of VAP due to A baumannii was found to be high in patients with neurosurgery (odds ratio [OR]=10.03; 95% confidence interval [CI]=1.55 to 64.90), ARDS (OR=9.73; 95% CI=1.60 to 59.24), head trauma (OR=5.17; 95% CI=0.88 to 30.34), and large-volume pulmonary aspiration (OR=2.90; 95% CI=0.80 to 10.53). CONCLUSIONS: Intubated patients who develop pneumonia and have any of the above factors are at an increased risk of Acinetobacter infection.

Acinetobacter↗
PubMed1997

[Diagnosis of pneumonia in intubated patients: a controversy without resolution?].

There is yet no accurate, fast, innocuous and inexpensive method for the diagnosis of pneumonia associated to ventilation (NAV). Here we analyse three diagnostic lines of increasing level of certainty. CLINICA METHOD: Associates radiological image, pus in the trachea and temperature changes and or leukocytosis. Although it is quite sensitive in the absence of distress, is it not very specific. Nevertheless, it must be appreciated for its function as a guide, recalling that in its absence bacterial counts are of scarce value. QUANTITATIVE BACTERIOLOGICAL STUDIES OF DEEP SPECIMENS: Broncho-alveolar lavage (BAL) and protected brush (PB) serve a double objective: to discriminate colonisation from infection, and the identification of the etiological agent. The sensitivity of BAL/PB is approximately 70% while specificity is close to 80%. The method performs better in the absence of previous antibiotic therapy. HISTOLOGICAL DIAGNOSIS: Almost never obtained while the patient is alive, it is nevertheless the golden standard. The absolute diagnosis of NAV is: histological for pneumonia, with a positive tissue culture. USE OF DIAGNOSIS IN THERAPY: Empirical treatment results in a 40% failure rate. The specific treatment requires therapeutic changes in more than 1/3 of cases. Treatment when the micro-organism is known is followed by longer survival. Perhaps the correct approach would be: early empirical treatment after taking deep samples and correction according to the results obtained.

Bronchoalveolar Lavage Fluid↗
PubMed1996

Renal collecting duct carcinoma in an 8-year-old child.

A fatal collecting duct carcinoma, presenting with pleural metastases, arose from the right kidney in an 8-year-old child. A distal nephron origin of the tumor is supported by positive tumor staining with Ulex europaeus and Arachis hypogaea, and a lack of staining with Tetragonolobus lotus. The ultrastructural features of short stubby microvilli, smooth basal cell membranes, and lateral membrane infoldings also support a distal nephron origin (inner most inner medullary collecting duct). This rare childhood renal neoplasm behaved similarly to that reported in adults with metastatic disease at presentation and a short fatal clinical course.

Carcinoma↗
PubMed1996

Essential thrombocythemia in an infant.

PURPOSE: To report the unusual occurrence of essential thrombocythemia (ET) in a 5-month-old infant. PATIENTS AND METHODS: The child was referred by her pediatrician for a high platelet count detected on routine blood testing. The child was asymptomatic except for failure to thrive. Diagnostic tests to rule out secondary causes of thrombocytosis as well as myeloproliferative syndrome were done. RESULTS: The platelet count persisted at > 1,000,000/microliters, and no secondary cause could be established. The bone marrow aspirate and biopsy showed normal cellularity, no fibrosis, orderly maturation, and normal morphology of all three cell lines, with only an increase in the number of megakaryocytes. A diagnosis of ET was established as per the Polycythemia Vera Study Group criteria. In view of the young age of the patient and asymptomatic course of the disease, we decided to observe the child only, reserving antiplatelet agents for use in the event of a thromboembolic or hemorrhagic episode. CONCLUSIONS: This is the youngest known child with ET. We believe that conservative observation is warranted in an asymptomatic child. The child is currently doing well and is asymptomatic 4.5 years after diagnosis.

Female↗
PubMed1996

Abdominal aortic aneurysm associated with childhood sarcoidosis.

Childhood sarcoidosis is a rare disease with multisystemic organ involvement. A wide spectrum of vasculitides, including large vessel involvement, have been reported in childhood sarcoidosis. We describe a 7-year-old boy with childhood sarcoidosis who presented with prolonged fever, iritis, and abdominal aortic aneurysm. He underwent successful surgical repair of the abdominal aortic aneurysm and followup for 12 months was uneventful. This is first report of abdominal aortic aneurysm complicating childhood sarcoidosis.

Aortic Aneurysm, Abdominal↗
PubMed1995

Nephroblastoma and end-stage renal failure with bilateral cystic kidneys.

A child of 10 years 5 months presenting with chronic renal failure had bilateral cystic kidneys. Biopsy of a right lower-pole solid mass revealed nephroblastoma. At bilateral nephrectomy, both kidneys were both replaced by variable-sized cysts with a unifocal nephroblastoma on the right. Renal failure with nephroblastoma is uncommon and is usually either a manifestation of the Drash syndrome or a complication of chemotherapy. The need to assess both kidneys in a child with any other renal abnormality in addition to a renal mass should always be considered.

Child↗
PubMed1995

Dermatofibrosarcoma protuberans with 46,XY,t(X;7) abnormality in a child.

A 9-year-old child with dermatofibrosarcoma protuberans demonstrated a balanced translocation, 46,XX,t(X;7)(q21l2;q11.2), in the untreated tumor, an abnormality not previously reported. Unlike seven of eight other reports of dermatofibrosarcoma protuberans, no ring chromosomes were present.

Child↗
PubMed1995

Case report: steroid sparing effect of intravenous gamma globulin in a child with necrotizing vasculitis.

This article reports the case of a boy aged 2 years 6 months, who had fever, arthritis, and necrotizing cutaneous vasculitis. Evaluation revealed no evidence of direct infectious causes. However, high anti-streptolysin and streptozyme titers during the acute phase support the possibility that streptococcal infection played an important role in the pathogenesis of this disease. The patient's condition improved significantly with the administration of prednisone. However, several attempts to diminish the prednisone dose resulted in relapses. Subsequently, the prednisone was successfully tapered and discontinued after intravenous gamma globulin administration. It is recommended that intravenous gamma globulin should be considered before immunosuppressive therapy in the treatment of necrotizing vasculitis.

Child, Preschool↗
PubMed1991

An application of mathematical models for decision making to the selection of policies on testing for drug use.

The object of the paper is to provide the basis to decide whether testing for drug use should be used, taking into consideration individual and social benefits and costs that the results of the tests could originate. In the analysis, special attention is paid to the fact that the actual costs of the tests themselves are not the most important elements of the social costs of a testing program. The most important costs are those generated by the defective results of the tests. They can provide false positive results, meaning that a nonuser is identified as a user, or false negative results in which a user is not identified as such. Social costs of the false positive results range from lowered worker morale to legal suits, while the false negative results eliminate any benefit that the identification of drug users could have. Combining all these elements, Correa and Woods specify a mathematical procedure as a decision tool to be used for determining whether a testing program should be implemented in specific industries or groups of industries. A complete implementation of the model is not carried out due to the lack of the required statistical information. However, preliminary trials showed that the conceptual and mathematical framework is operational, and that the model prepared could be used as a guideline for collecting the most appropriate data for decision making.

Adult↗
PubMed1984

Visual evoked potentials and brain stem auditory potentials in Friedreich's ataxia--a longitudinal study.

Six patients with Friedreich's ataxia, 4 males and 2 females, their ages ranging from 13 to 33 years, were studied. The early manifestations started between age 7 and 13 with an evolution time between 6 and 20 years. Serial visual and brain stem auditory evoked potential recordings were made. A progressive increase in latency, reduction in amplitude and in latency inter-ocular difference of P100 were observed. The pattern of the reversal checker-board visual evoked potential was preserved. A disorganized BAEP pattern, a well defined potential I, a very small potential V and a delay in the interpeak latency were constant findings. The assumption is made of a progressive involvement of both visual and central auditory pathways. Pathophysiological mechanisms are discussed.

Adolescent↗