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Biomedical subjects

J Barrón

Publications and source records attributed to J Barrón.

At least 19 recordsLinked to original sources
PubMed2005

Orogenital transmission of Neisseria meningitidis serogroup C confirmed by genotyping techniques.

Urethritis caused by Neisseria meningitidis in heterosexual patients is presumed to occur via orogenital contact, but confirmation has not been possible in most cases. Presented here is a case of urethritis caused by N. meningitidis, serogroup C, and the isolation of the same microorganism from the nasopharynx and endocervix of the patient's sexual partner. The similarity of the urethral and nasopharyngeal isolates' electrophoretic patterns, obtained using pulsed-field gel electrophoresis, proves the infection was transmitted via orogenital contact.

Adult↗
PubMed2000

[Keratitis caused by Acanthamoeba spp.: presentation of 10 cases].

OBJECTIVE: To describe the clinical and microbiological characteristics of ten patients with Acanthamoeba spp. keratitis. METHODS: A retrospective review was made of the clinical charts of ten patients with both clinical keratitis and positive culture for Acanthamoeba spp. from 1992 (date of first diagnosed case in our hospital) on. Corneal tissue was cultured in Page media and also the contact lenses and maintenance or cleaning fluids used by each patient. RESULTS: The earliest clinical symptom observed in 60% of cases was foreign-body sensation. Before the parasitologic studies all the patients received different treatments for 4 days minimum to a maximum of 3 months. On ophthalmological examination the findings were: radial perineuritis in 4 cases, anular infiltrate in two, keratitis punctata in two and pseudodendritic ulcer in two more. Treatment employed was the following: propamidine and neomycin in 8 patients (four of them also received ketoconazole); biguanides in two. After a mean observation time of 7 months (minimum 4, maximum 10) the clinical status was favorable in 70% of cases. In three patients with delayed diagnosis of 2 to 3 months a keratoplasty was needed. COMMENTS: Acanthamoeba spp. keratitis is a process of difficult diagnosis and treatment. For early detection of this disease a narrow collaboration with the microbiologist is mandatory because the prognosis in this patients depends on the precocity of treatment.

Acanthamoeba↗
PubMed1999

Predisposing factors to bacterial colonization in chronic obstructive pulmonary disease.

The aim of this prospective observational study was to determine those factors influencing bacterial colonization in patients with stable chronic obstructive pulmonary disease (COPD). Eighty-eight outpatients with stable COPD and 20 patients with normal spirometry and chest radiography (controls) had a fibreoptic bronchoscopy performed with topical aerosol anaesthesia. Bacterial colonization was determined using the protected specimen brush (PSB) with a cut-off > or = 10(3) colony-forming units (CFU x mL(-1)). The influence of age, degree of airflow obstruction, smoking habit, pack-yrs of smoking, and chest radiographic findings on bacterial colonization were assessed by univariate and multivariate analysis. Significant bacterial growth was found in 40% of patients and in none of the controls. Haemophilus influenzae, Streptococcus viridans, S. pneumoniae and Moraxella catarrhalis were the most frequent pathogens. After adjustment for other variables, severe airflow limitation (odds ratio (OR) 5.11, 95% confidence interval (CI) 1.45-17.9) and current smoking (OR 3.17, 95% CI 2.5-8) remained associated with positive bacterial cultures. When only potentially pathogenic micro-organisms were considered, significant bacterial growth was found in 30.7% of patients, with severe airflow obstruction (OR 9.28, 95% CI 2.19-39.3) being the only variable independently associated with positive bacterial cultures. Our results show that stable chronic obstructive pulmonary disease patients have a high prevalence of bacterial colonization of distal airways which is mainly related to the degree of airflow obstruction and cigarette smoking.

Aged↗
PubMed1998

[Usefulness of bronchoalveolar lavage in the renal transplant patient with suspected respiratory infection].

In this retrospective study we aimed to assess the diagnostic yield of bronchoalveolar lavage (BAL) in kidney transplant patients who were suspected of having severe respiratory infection or in whom empirical antibiotic treatment had failed. All BAL procedures performed on kidney transplanted patients suspected of having respiratory infections between January 1, 1988 and July 31, 1996 were analyzed. BAL was carried out in the standard way and samples were sent for cytologic and bacteriologic study. Thirty-three patients with a mean age of 48.5 years were enrolled. All had been receiving immunosuppressive treatment and the mean time following transplantation was 320 days. Thirty-one had received antibiotic treatment before BAL. BAL was positive for 21 of the 33 patients (64%). Twenty-two pathogens were identified: 6 Pneumocystis carinii, 4 Cytomegalovirus, 3 Mycobacterium tuberculosis, 2 Aspergillus fumigatus, 2 Herpes simplex type I, 1 Streptococcus pneumoniae, 1 Staphylococcus aureus, 1 Streptococcus mitis, 1 Legionella pneumophila, 1 Legionella longbeachae. BAL was negative for 12 patients, of whom 8 were tentatively diagnosed of bacterial infection, 3 of acute pulmonary edema and one of pulmonary infarction. Based on the results, therapy was changed for 20 patients (61%), 19 (58%) because an unsuspected pathogen was identified and 1 because treatment could be simplified. The diagnostic yield of BAL is high (64%) in kidney transplant patients suspected of respiratory infection and is useful for managing such cases, as evidenced by the fact that a high proportion (19/33) of our patients were infected by pathogens not covered by empirical treatment.

Adolescent↗
PubMed1997

[Peracetic acid: alternative to the sterilization of bronchofibroscopes].

The Steris system for cold sterilization with peracetic acid was evaluated by effecting a series of contaminations of a fiberoptic bronchoscope (FB) with specimens of Pseudomonas aeruginosa, Acinetobacter baumanii and Mycobacterium kansasi. The FB was contaminated 24 times, 8 times by each microorganism, using specimens containing more than 10(8) cfu/ml. After fixing the secretions on the FB and washing it with enzyme soap, the BF was sterilized. Specimens were taken for culturing after contamination of the FB, after washing, immediately after sterilization and 1 hour after sterilization. No microorganism growth of any of the samples was detected either immediately after sterilization or one hour later. Microbiological data confirmed contamination of the FB after aspiration and fixation of the inoculate. Chemical and biological tests with B. stearothermophilus spores as specified by the manufacturer were correct in all cases: 24 contaminations and 52 processes of prior training. The efficacy of washing with enzyme soap before sterilization stands out. In 14 of the 24 samples, culture was negative after washing and in 7 the concentration of microorganisms was less than 500 cfu/ml, which confirms the need for appropriate washing before any disinfection or sterilization process is begun. In conclusion, the Steris system based on peracetic acid is an alternative to other systems for cold sterilization or high level disinfection.

Acinetobacter↗
PubMed1997

[Protected bacteriologic brushing in patients with severe copd].

To determine the presence of germs and their concentration in a group of patients with severe chronic obstructive pulmonary disease (COPD) (FEV1 < 50%), some of whom were in stable condition and others of whom were in acute phase. Twenty-six patients with severe COPD (14 stable and 12 acute phase) were enrolled. None had received prior antibiotic or corticoid treatment. The stable patients had no signs or symptoms of exacerbation, whereas the acute-phase patients had increased dyspnea, sputum volume and purulence. The patients received aerosol rather than liquid anesthesia when PSB sampling was performed. A PSB finding was considered positive at a level > or = 10(3) CFU/ml. There were no significant differences between the groups with respect to age, sex, proportion of smokers and ex-smokers or packs per year. The only spirometric measure that was significantly different was (FEV1/FVC, which was lower in the acute-phase group (p < 0.05). Positive PSB findings were recorded for 57.1% of the stable patients and for 66.7% of the acute-phase patients (p = NS). H. influenzae was the microorganism found most often in both groups. The mean CFU/ml level was 8,625 in stable patients and 17,375 in acute-phase patients (p = NS). A large proportion of stable patients (57.1%) with severe COPD harbor significant concentrations of germs as revealed by PSB sampling. Germ concentrations were found in a non significantly greater number of acute-phase patients, confirming the lack of congruence between clinical status and bacteriological condition.

Aged↗
PubMed1997

Acute dopaminergic blockade augments the naloxone-induced LH rise in estrogen-treated postmenopausal women.

OBJECTIVES: To assess the effect of estrogen replacement on the simultaneous blockade of the dopaminergic (DA) and opioidergic neural control of hypothalamic-gonadotropic function in postmenopausal women. METHODS: Twenty healthy postmenopausal women, 48-55 years old were randomly assigned to receive either a 4-h naloxone infusion at 2 mg/h (group 1, n = 7) or a 10 mg i.v. bolus of metoclopramide (group 2, n = 7) or both drugs, simultaneously (group 3, n = 6) before and after 3 weeks of transdermal estradiol (100 microg/day). Blood samples were obtained at 30-min intervals during 4 h and duplicate determinations of serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2) and prolactin (PRL) were performed in all samples. RESULTS: In group 1 only a mild but significant LH rise after but not before estrogen replacement was seen. In group 2 PRL had a greater rise after than before estrogen therapy, without other hormonal changes. In group 3 a greater rise in PRL occurred after than before estrogen administration and serum LH had a sustained rise throughout the test only after estrogen replacement (greater than in group 1). No FSH changes were observed. The after-estradiol PRL response was nearly similar in groups 2 and 3. CONCLUSIONS: Our results indicate that in the untreated postmenopausal women, the dopaminergic system has little and the opioidergic system has no significant input in the control of gonadotropin or prolactin release. However, following estrogen replacement, opioids are involved in the inhibition of LH release and stimulating PRL release, while the dopaminergic system acts to inhibit PRL release and modulates LH release or inhibition, depending on the levels of circulating estrogens.

Dopamine↗
PubMed1997

Differences in the metoclopramide-induced prolactin release related to age at first full-term pregnancy or nulliparity.

To investigate if an association exists in parous women between metoclopramide-induced prolactin (PRL) release and chronological age at first full-term pregnancy and to compare their response to a group of non-parous women, we studied 139 healthy, non-lactating women, aged 15.8-48.2 years, on days 18-22 of their menstrual cycle (except two post-menopausal women). There were 61 parous women divided according to chronological age at first full-term pregnancy: 22 were aged < or = 20.0 years, 25 were aged 20.1-29.9 years and 14 were aged > 30 years. There were also 50 nulliparous women and 28 women who had experienced only first trimester abortions. Three basal blood samples were obtained before oral metoclopramide (10 mg) was administered; subsequently samples were taken at 60, 90 and 120 min. Duplicate serum PRL determinations were performed by radioimmunoanalysis and the area under the curve (AUC) calculated. In parous women, the PRL AUC was positively correlated with chronological age at first full-term pregnancy (P < 0.0001), and it was lower than in nulliparous women or in women with abortions. These data suggest that in parous women a greater dopaminergic tone may exist compared with non-parous women, which seems to decrease gradually as chronological age at first full-term pregnancy increases.

Age Factors↗
PubMed1995

Serum androgen changes during meal-induced hyperinsulinemia and after acute sequential blockade and hyperstimulation of insulin release in women with polycystic ovary syndrome.

To investigate if acute changes in endogenous insulin release are associated with similar changes in serum androgen, 13 healthy ovulatory women (group 1) and six women with polycystic ovary syndrome (PCOS) and hyperinsulinemia, three with acanthosis nigricans (group 2) were studied. On day 1 all women ingested a 725 kilocalories breakfast between 7:30 and 8:00 A.M. The next day (day 2) only PCOS women had the breakfast and a simultaneous 90-min intravenous infusion of epinephrine (E, 6 micrograms/min) and propranolol (P, 80 micrograms/min). On both days serum glucose, insulin, cortisol, 17 alpha hydroxyprogesterone (17 OHP), dehydroepiandrosterone sulfate (DHEAS), free testosterone (free T), and androstenedione (A) were determined every 30 min for a period of 3 h. In group 1, glucose, insulin, free T, and DHEAS simultaneously rose (p < or = 0.026) while cortisol and 17 OHP fell (p < or = 0.020). Group 2 on day 1 had fasting and meal-stimulated hyperinsulinemia but all serum steroids progressively decreased. In only one woman free T rose. On day 2 during the E + P infusion, glucose increased yet fasting insulin remained constant and serum steroids decreased again. During the 90 min post-infusion, insulin sharply increased but no acute elevation in any steroid occurred. In conclusion, in PCOS women no parallel changes in serum androgen concentrations were seen in association with acute truly physiologic endogenous hyperinsulinemia or during the acute pharmacologically induced hypoinsulinemia and subsequent hyperinsulinemia.

Adult↗
PubMed1994

[Current use of penicillin in community-acquired pneumococcal pneumonias].

BACKGROUND: A retrospective study was performed to know the clinical and microbiologic aspects of community-acquired pneumococcal pneumonia in adult patients admitted to a general hospital from 1990-1992. METHODS AND RESULTS: The medical records of 55 patients, aged 20-86 years (man age: 58 year) were reviewed. Streptococcus pneumoniae was isolated from blood in 45 cases (81.8%), transparietal lung puncture in 5 (9.1%), pleural fluid 3 (5.5%) and protected specimen brushing (> 1,000 UFC/ml) in 2 (3.6%) Most isolated (80%) were sensitive to penicillin (CIM < 0.1 microgram/ml); intermediate (CIM > or = 0.1 microgram/ml) 9 (16.4%) and resistant (> 1 microgram/ml) 2 (3.6%). Underlying diseases were present in 39 (70.9%) cases. All patients received empiric treatment with one or more antibiotics effective against Streptococcus pneumoniae. Only in 2 of the 9 cases treated with erythromycin the microorganism was resistant to this drug. Eleven patients died (20%), 5 died before to the fifth day of admission. Mortality was influenced by involvement of 2 or more lobes and immunosuppression (p < 0.05). CONCLUSIONS: This study suggests that 80% of the community-acquired pneumococcal pneumonia in a population with a high prevalence rate of disease requiring hospital admission are very sensitive in vitro to penicillin in contrast with its seldom clinical use in the authors environment. No microorganism presented with CIM above 2 micrograms/ml. Mortality was not due to inadequate therapy but rather to the severity of the underlying disease.

Adult↗
PubMed1991

[Evaluation of bronchoalveolar lavage in the microbiological diagnosis of pneumonia in patients at risk].

Bronchoalveolar washout was performed in 130 patients with pneumonia during a period of 28 months. Microbiological investigation involved common bacteria, Legionella, fungi, viruses (Cytomegalovirus, herpes, RSV), Mycobacterium, and Pneumocystis carinii. Infection HIV was present in 75% of patients. The remaining patients had malignant diseases or severe pneumonia. The overall sensitivity of the technique was 65.4% and the positive predictive value was 92%. The technique was less sensitive in cases of bacterial pneumonia (sensitivity = 34.4%). This was attributed to the fact that 82.8% of these cases received antibiotic therapy. Pneumocystis carinii and Mycobacterium tuberculosis were the most common agents (44.8% and 34.5%, respectively). In seven instances the clinical picture was related to cytomegalovirus, although this diagnosis can not be easily done.

Adolescent↗
PubMed1980

The laparoscopic diagnosis of the liver fascioliasis.

The laparoscopic findings in 18 cases of liver fascioliasis are described. The characteristic lesions are white and yellow cords on the liver surface that delineate the necrotic tunneliform areas created by the parasite as it penetrates the hepatic tissue. The peritoneum adjacent to the liver also is frequently involved. There was ascites in the 22.2% of the cases. Guided laparoscopic biopsy of peritoneal nodules and of visible liver lesions yielded significant findings more often that percutaneous liver biopsy alone.

Biopsy↗
PubMedDate not supplied

[Infection and colonization by Scedosporium prolificans].

BACKGROUND: Scedosporium prolificans is a dematiaceous fungus that is known to cause a wide spectrum of infections in humans, bearing a severity and a prognosis that is relationed with the patients immune status. METHODS: A retrospective review was made of the clinical charts of all patients who developed positive S. prolificans cultures in our centre from 1990 to 2000. Isolates were identified by colonial morphology and microscopic features. The in vitro susceptibility was evaluated using the microdilution method according to NCCLS. RESULTS: S. prolificans was isolated in 15 patients. Eight were affected with cystic fibrosis and the isolation of S. prolificans in their airways did not worsen their clinical status. Among the remaining 7 cases there were five leukemic patients with neutropenia and two immunocompetent hosts with cutaneous infection and endocarditis. Four of five neutropenic patients died of sudden sepsis and S. prolificans was isolated from blood cultures made a few days before their death, and the fifth neutropenic case suffered a bilateral pneumonia with improving course probably due to recovery from neutropenia. As to the immunocompetent group the clinical course was good in the cutaneous infection case, but the endocarditis case died four days after the antifungical therapy was started. All the isolates tested were found to be resistant to amphotericin, 5 flucytosine, fluconazole, itraconazole, voriconazole, miconazole and terbinafine. CONCLUSIONS: Scedosporium prolificans is a fungal pathogen that colonizes the airways of patients affected with cystic fibrosis. It can also cause a wide variety of infections, whose severity and prognosis depends on the patients immune status. Due to the resistance of this fungus to antifungal drugs, the therapeutic options are limited. Only with the correction of neutropenia and surgery in local infections in immunocompetent hosts it has been possible to cure these infections.

Acute Disease↗
PubMedDate not supplied

[Microbiological diagnosis of patients undergoing ambulatory peritoneal dialysis].

A prospective study was performed to evaluate two culture methods for the diagnosis of bacterial peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD): a total bag volume method, and culture of 50 ml with prior saline wash. Peritonitis was present in 45 patients (47.4%). The wash method was more sensitive (80%) than bag culture method (62.2%), specially in patients with antimicrobial drugs therapy (p < 0.05). Therefore, specificity was greater for the bag procedure (78% vs. 62%).

Adolescent↗