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Biomedical subjects

J Ena

Publications and source records attributed to J Ena.

36 records · Page 2Linked to original sources
PubMed1994

Low-dose oral chloroquine in patients with porphyria cutanea tarda and low-moderate iron overload.

OBJECTIVE: to assess the efficacy, tolerance and determinants for relapse in patients with porphyria cutanea tarda treated with low-dose oral chloroquine. DESIGN: open trial with a median follow-up of 3 years. SETTING: outpatient referral unit of a university hospital. PATIENTS: 53 patients with low-moderate iron overload or intolerance to phlebotomies. INTERVENTION: 250 mg twice weekly oral chloroquine diphosphate until remission or failure to respond. MEASUREMENTS: porphyrin excretion, biochemical changes and development of side effects. RESULTS: after administration of a median dose of 23.5 g of chloroquine (limits 12.6-56 g) during a median time of 8 months (limits: 1-26 months), 50 patients (94%) reached a metabolic remission (urinary uroporphyrin excretion < 100 micrograms/l). In 14 of these patients (28%), porphyrin excretion further decreased after finishing chloroquine therapy. Metabolic remission persisted during 24 months (limits 6-97 months). Side-effects (severe pruritus) appeared only in one patient. Twenty-two patients relapsed, the relapses being associated with greater basal values of serum AST, ALT, gammaglobulin, urinary uroporphyrin and to the time needed to achieve remission. One year and three years after finishing therapy the probabilities of relapse were 12% (95% C.I.: 5-27%) and 49% (95% C.I.: 34-67%), respectively. Time to achieve remission was the only independent predictor of relapse (hazard ratio: 1.2, 95% C.I.: 1.05-1.21, P < 0.01). CONCLUSION: low-dose oral chloroquine is a safe therapy that promotes a high proportion of remission and sustained control of porphyria cutanea tarda associated with low-moderate iron overload.

Administration, Oral↗
PubMed1994

Epidemiology of Staphylococcus aureus infections in patients on hemodialysis.

OBJECTIVE: To determine the epidemiology of Staphylococcus aureus infections in hemodialysis patients. METHOD: S aureus isolates from surveillance cultures and from sites of infection were evaluated by both bacteriophage typing and restriction endonuclease digestion of plasmid DNA. SETTING: A hemodialysis unit in Brugge, Belgium. ORGANISMS: S aureus isolates from 11 chronic hemodialysis patients who had participated in the placebo arm of a previously reported placebo-mupirocin comparative study. RESULTS: Of 75 S aureus isolates evaluated, 63 were from cultures of nares and 12 from infections (three arteriovenous fistula infections, four wound infections, and five bacteremias). All isolates were typed by bacteriophages and 56 (75%) had plasmids. Three patients developed 12 infections. Eleven infections were caused by isolates previously identified in surveillance cultures. Only one infection was caused by a strain not identified previously in surveillance cultures. CONCLUSION: These results support the hypothesis that S aureus isolates causing infections in hemodialysis patients are of endogenous origin.

Aged↗
PubMed1994

Once-a-month administration of intravenous pentamidine to patients infected with human immunodeficiency virus as prophylaxis for Pneumocystis carinii pneumonia.

We reviewed the charts of 52 patients infected with human immunodeficiency virus (HIV) who received at least three consecutive doses of intravenous pentamidine as prophylaxis for Pneumocystis carinii infections. Pentamidine isethionate was administered intravenously over 60-90 minutes once a month, at a dosage of 4 mg/kg, in 250 mL of 5% dextrose in water. During 387 months of administration of primary prophylaxis to 37 patients, no cases of P. carinii pneumonia were observed. During 200 months of administration of secondary prophylaxis to 15 patients, only one case of P. carinii pneumonia was diagnosed (6.0 cases per 100 patient-years). Side effects associated with the intravenous pentamidine were mild and did not necessitate withdrawal of the drug. Once-a-month administration of intravenous pentamidine is a valid alternative as prophylaxis for P. carinii pneumonia for patients who are intolerant of sulfonamides.

Adult↗
PubMed1994

Impact of an educational program for the prevention of colonization of intravascular catheters.

OBJECTIVE: To evaluate the efficacy of an educational program for the prevention of catheter colonization. DESIGN: Two cross-sectional studies were carried out in a 500-bed randomly selected area of the hospital, separated by an educational program on the care of intravenous lines based on the Centers for Disease Control and Prevention (CDC) recommendations for the control of catheter-related infections. SETTING: A 2,100-bed urban general hospital affiliated with the University of Madrid (Spain). METHODS: Characteristics of patients and catheters and appropriateness of catheter care were evaluated. Cultures were taken from the point of insertion of the vascular catheter, the hubs, and infusion fluids. When catheter-associated infection was suspected, the distal end of the catheter was sent for culture and two blood cultures were taken. We compared the clinical and microbiological data before and after carrying out an educational program based on CDC recommendations for the control of catheter-related infections. RESULTS: Characteristics of patients and catheters did not differ between the two cross-sectional studies. Compared with baseline data, after the educational program we observed a reduction of inappropriate catheter care, from 83% to 38% (45% difference, 95% confidence interval [CI95], 55% to 35%, P < 0.0000), and a reduction in the rate of skin colonization, from 34% to 18% (16% difference, CI95, 26% to 5%, P < 0.001). The frequency of phlebitis (15% versus 14%), hub colonizations (12% versus 11%), catheter colonizations (2% versus 1%), and catheter-related bacteremias (0% versus 0%) remained unchanged between the two cross-sectional studies. CONCLUSIONS: Our educational program improved catheter care and reduced significantly the proportion of skin colonization around the insertion point. However, the educational program did not modify the proportion of hub colonization; because hub colonization has been demonstrated to be a source of line sepsis, our data suggest the need for a specific program directed to the maintenance of catheter hubs.

Adult↗
PubMed1993

The epidemiology of intravenous vancomycin usage in a university hospital. A 10-year study.

OBJECTIVES: To examine the trends of intravenous vancomycin usage during a 10-year period, to classify the indications for which physicians prescribed the antibiotic, and to identify the independent predictors for empirical use of vancomycin. DESIGN: A descriptive epidemiological study, a cross-sectional study, and a case-control study were performed. SETTING: A 900-bed university-teaching hospital. MAIN OUTCOME MEASURES: The annual crude usage (grams) and incidence density (grams/1000 patient-days) of vancomycin were measured for 10 years (July 1981 to July 1991). In 109 randomly selected patient medical records, we evaluated the proportion of usage of vancomycin classified as prophylaxis, empirical therapy, or specifically directed therapy. Univariate and multivariate analyses were performed to identify determinants of empirical administration of vancomycin vs a penicillase-resistant penicillin to 64 case patients and 64 control patients. RESULTS: The rate of vancomycin usage increased 20-fold from 5.72 g/1000 patient-days in 1981 to 121.25 g/1000 patient-days in 1991. The use of vancomycin was significantly higher (P < .0001) in hematology-oncology areas compared with that in other hospital areas. The rates for each indication for vancomycin were 35.0% for prophylaxis 31.8% for empirical therapy, and 33.2% for therapy specifically directed by culture results. In a multivariate analysis, the presence of "plastic" medical devices was the best independent predictor for patients receiving vancomycin: intravenous lines (odds ratio [OR], 6.23; 95% confidence interval [CI], 2.28 to 17.06; P < .001), Hickman catheters (OR, 76.12; 95% CI, 15.06 to 384.73; P < .001), and other medical devices (OR, 10.50; 95% CI, 2.54 to 43.38; P = .001). CONCLUSIONS: Vancomycin use has increased linearly in the last decade primarily related to the presence of indwelling vascular devices in hematology-oncology patients. Use of vancomycin is equally divided among empirical therapy, prophylaxis, and specific therapy for a documented infection.

Case-Control Studies↗
PubMed1993

Trends in gram-positive bloodstream organism resistance: a seven-year audit of five glycopeptides and other drugs at a large university hospital.

Gram-positive pathogens (n = 525) isolated from bloodstream infections were tested by a reference broth microdilution method to establish antibiotic susceptibility trends (1985 to 1991). Cefazolin, ciprofloxacin, gentamicin, novobiocin, oxacillin, rifampin, teicoplanin, vancomycin, trimethoprim/sulfamethoxazole, daptomycin and two investigational glycopeptides (LY264826 and MDL62873) were investigated. Strains were selected without bias (first two isolates each month/species; no patient duplicates) as follows: 132 Staphylococcus aureus, 129 Staphylococcus epidermidis, 72 Staphylococcus haemolyticus, 130 Enterococcus faecalis and 62 other enterococci. All isolates were susceptible to vancomycin and teicoplanin except for Staphylococcus haemolyticus which had a resistant teicoplanin MIC90 of 64 micrograms/mL. The susceptibilities to vancomycin and teicoplanin were unchanged over the monitored period. Daptomycin, LY264826 and MDL62873 also demonstrated consistent activity; MDL62873 being superior with a MIC90 of 0.12 micrograms/mL. In 1990-1991 a significantly increased resistance to ciprofloxacin was observed among oxacillin-resistant strains of staphylococci. Our data suggest that the emergence of invasive vancomycin-resistant strains in Gram-positive isolates remains a rare phenomenon. However, we have experienced an emergence of numerous ciprofloxacin-resistant strains among staphylococci that precludes its empirical use at our institution.

Anti-Bacterial Agents↗
PubMed1992

Cross-sectional epidemiology of phlebitis and catheter-related infections.

OBJECTIVES: To describe the characteristics and the problems arising from the use of vascular catheterization in a general hospital and to identify avoidable risk factors associated with catheter-related infections. DESIGN: Cross-sectional, including the entire hospitalized population. SETTING: A university-affiliated hospital. RESULTS: Three-hundred fifty-three intravascular catheters were implanted in 315 of a total of 1,838 hospitalized patients (17.1%, confidence interval [CI] = 15.7-18.5). Of the 353 intravascular catheters, 26 (7.3%) were intra-arterial, 273 (77.3%) were peripheral, and 54 (15.3%) were central. The median (range) duration of the catheterization was 3 (1-11) days for arterial catheters, 1 (1-24) for peripheral catheters, and 5 (1-130) for central catheters. Fifty-three (15%, CI = 11.5-19.5) showed signs of infection. Independent risk factors associated with infection were the presence of infection located elsewhere (odds ratio [OR] = 8.7, CI = 4.13-18.3, p less than .0001), inappropriate catheter care (OR = 5.3, CI = 2.5-11.2, p less than .0001), inappropriate length of catheter use (OR = 3.5, CI = 1.4-9.02, p less than .01), and duration of hospitalization exceeding 14 days (OR = 2.6, CI = 0.9-7.83, p = .07). CONCLUSION: The risk factors associated with catheter-related infections suggest that many are preventable by improved protocols for management. This hypothesis can easily be tested.

Adolescent↗
PubMed1990

[The usefulness and limitations of adenosine deaminase in the diagnosis of tubercular pleurisy. A meta-analytical study].

To assess the yield of adenosine deaminase (ADA) measurement in the diagnosis of tuberculous pleuritis and to afford parameters applicable to different populations and risk groups, a meta-analysis was performed in this study. National and anglo-saxon studies included in the Index Medicus from 1980 to march of 1990 were reviewed. The estimated incidence of tuberculous pleuritis in our medium was about 0.18 (confidence intervals for 95%-95% CI: 15-0.21). The diagnostic yield of ADA was as follows: sensitivity of 0.99 (95% CI: 0.98-0.99) and specificity of 0.93 (95% CI: 0.91-0.94). The quotients of probability (parameters that measure the predictive values of the tests at any given prevalence) were 14.31 and 0.004 for the positive and negative tests, respectively. In or medium the positive and negative predictive values were 0.74 (95% CI: 0.68-0.81) and 0.99 (95% CI: 0.98-0.99), respectively. An ADA value below the discriminative level nearly rules out the existence of tuberculous pleuritis, whereas at the contrary, and ADA value above the discriminative point offers a limited information about the etiology of the pleural effusion.

Adenosine Deaminase↗
PubMed1990

A conservative procedure for the diagnosis of catheter-related infections.

A prospective study was done in 139 intravascular catheters (IVCs) that had been removed for different reasons. The purpose of the study was to compare laboratory procedures for the diagnosis of catheter-related infections and also to attempt to clarify the present controversy regarding the portal of entry of such infections. The IVCs were removed by one of us and multiple samples were studied according to a standard procedure. Semi-quantitative cultures were performed of the tips, the interior of the hub, and the skin around the insertion point. Quantitative cultures were performed of the infusion fluid and of the IVC tips. Of the 139 IVCs studied, 53 (38.1%) were infected (greater than or equal to 15 colony-forming units per plate in the semiquantitative culture). Semi-quantitative and quantitative cultures gave comparable results, but the semiquantitative procedure proved to be easier and faster. All but three infected catheters had a positive (greater than or equal to 15 colony-forming units per plate) skin and/or hub culture (superficial cultures), with microorganisms identical to those isolated in the IVC tip. Our results showed two possible and differentiable portals of entry. Thirty (56.6%) had external origin (semiquantitative skin culture positive), 12 (22.6%) had an internal origin (semiquantitative hub culture positive), and 8 (15.1%) had both origins. All catheters with negative superficial cultures had a negative tip. The predictive value of positive superficial cultures in the diagnosis of catheter-related infection was 66.2% and that of negative cultures was 96.7%. In patients with suspected catheter-related infections but negative superficial cultures, the possibility of infection may reasonably be ruled out, thereby avoiding many unnecessary catheter withdrawals.

Adolescent↗