PubMed Health⌕ Search

Biomedical subjects

J R Gómez

Publications and source records attributed to J R Gómez.

13 recordsLinked to original sources
PubMed2000

[Risk factors and prognosis of nosocomial pneumonia due to gram-negative bacteria in a general hospital].

Nosocomial pneumonia due to Gram-negative bacteria is one of the most important infections because of its high frequency, morbidity and mortality. The objective of this study was to determine the risk factors and prognosis for nosocomial pneumonia caused by Gram-negative bacteria. A group of 50 patients with nosocomial pneumonia due to Gram-negative bacteria were studied in a prospective, consecutive manner and compared with another group of 50 patients with similar characteristics but without infection. The diagnostic criteria, acquisition, previous infections, prognosis of the underlying disease, the initial severity of the clinical situation, presence of complications, type and evolution of antibiotic treatment were adjusted according to the criteria in the literature. Univariate and multivariate statistical analysis of the results was carried out. The risk factors found included the following: male sex, high-risk hospital units, nosocomial acquisition and previous manipulation with intubation and mechanical ventilation, previous pulmonary infections, and the use of wide-spectrum antibiotics in the six weeks prior to the study. The most isolated Gram-negative bacterium was Pseudomonas aeruginosa (32%), followed by polymicrobial flora (18%). Bacteriemia was found in 30% of the cases. Mortality was 24%, with the factors significantly associated with a poor prognosis being a serious underlying disease, a clinically critical situation, previous surgery, complications, Gram-negative bacteria, use of wide-spectrum antibiotics in the six months before the study, and advanced age. The mortality of the group was 8%. It was concluded that knowledge of the risk factors and prognosis of nosocomial pneumonia due to Gram-negative bacteria is of high importance to improve treatment and decrease morbidity and mortality.

Anti-Bacterial Agents↗
PubMed2000

[Risk factors and prognostics of urinary infections due to gram-negative bacteria].

Urinary infections due to gram-negative bacteria are important because of their high frequency, morbidity and mortality. In order to evaluate the risk factors and prognostics a group of 50 patients with nosocomial urinary infections were studied prospectively and consecutively and were compared with another group of 50 patients with similar characteristics but no infection. The most isolated bacteria were Escherichia coli (68%), followed by Pseudomonas aeruginosa (20%). Bacteremia was found in 22% of the cases. Risk factors included female gender, medical services, nosocomial acquisition, previous use of manipulation techniques such as vesicular probe, prior urinary infections, and the use of cytostatic drugs in the previous six weeks. Mortality was 4%. The factors significantly associated with a poor prognosis were the following: severe underlying disease, a clinically critical situation, previous surgery, complications, type of gram-negative bacteria, use of third generation cephalosporins and ciprofloxacin in the previous six weeks and older age. The mortality of the control group was 8%.

Adult↗
PubMed2000

[Risk factors and prognostics of nosocomial infectionof surgical wounds in a general hospital].

Surgical infections due to gram-negative bacteria are important because of their high frequency, morbidity and mortality. In order to evaluate the risk factors and prognostics of gram-negative surgical wound infections a group of 50 patients with surgical infections were studied prospectively and consecutively and were compared with another group of 50 patients with similar characteristics but no infection. No significant differences were observed with respect to age between the two groups. Previous surgery, prior surgical infections and use of wide-spectrum antibiotics in the six weeks before the study were significantly associated with the development of surgical wound infections due to gram-negative bacteria. The most isolated bacteria were Pseudomonas aeruginosa (34%), followed by polymicrobial flora (16%). The factors significantly associated with a poor prognosis were the following: severe underlying disease, a clinically critical situation, previous surgery, arterial hypertension, complications, type of gram-negative bacteria, prior use of wide-spectrum antibiotics in the previous six weeks and older age. No deaths occurred.

Cross Infection↗
PubMed1997

Comparison of three prophylactic antibiotic regimens in clean-contaminated head and neck surgery.

BACKGROUND: Although appropriate perioperative antibiotic prophylaxis has significantly reduced wound infection rates in clean-contaminated head and neck surgical procedures, controversy still remains regarding the optimal antibiotic regimen. METHODS: In this prospective, double-blind clinical trial, 159 patients were randomized to receive amoxicillin-clavulanate, clindamycin plus gentamicin, or cefazolin intravenously up to 1/2 hour before surgery and at 6-hour intervals for an additional three doses. RESULTS: An overall wound infection rate of 23% was observed. Thirteen (22.8%) infections occurred in the amoxicillin-clavulanate-treated group, 11 (21.2%) in the clindamycin plus gentamicin-treated group, and 13 (26%) in the cefazolin-treated group, which was not statistically significant. Only prior medical illnesses, such as chronic obstructive pulmonary disease and diabetes mellitus, correlated with an increased wound infection rate (p = 0.018). CONCLUSIONS: Amoxicillin-clavulanate, clindamycin plus gentamicin, and cefazolin seem to have similar efficacy when administered prophylactically in clean-contaminated head and neck surgical procedures.

Adult↗
PubMed1997

Genotype-specific RNA probes for direct identification of wild polioviruses by blot hybridization.

We have developed RNA probes for the direct identification of wild poliovirus isolates by blot hybridization. The probes are complementary to sequences of the first 30 to 32 codons of VP1, which evolve more extensively (approximately 1.5-fold) than the rest of VP1. To illustrate our general approach, we describe the design of probes specific to each of four major genotypes recently endemic (1981 to 1991) to the Americas: Andean type 1, Brazil type 1, Brazil type 3, and Central America-Mexico type 3. A wild isolate of each genotype was selected according to molecular and epidemiologic criteria to be representative of the principal lineages in circulation. Variable VP1 sequences of the representative isolates were amplified by the reverse transcriptase PCR and were inserted into a plasmid vector containing a T7 promoter. The in vitro transcripts, labeled with digoxigenin, served as probes. These formed stable hybrids only with RNAs of isolates of the corresponding genotypes. Hybrids were detected by a sensitive chemiluminescence assay, capable under normal diagnostic conditions of detecting specific wild poliovirus sequences in samples containing up to a 100-fold excess of Sabin vaccine strain-related sequences of the same serotype.

Base Sequence↗
PubMed1997

Pneumoperitoneum: its alternatives.

The purpose of this study was to determine the advantages and disadvantages of several techniques for performing the pneumoperitoneum. We studied 75 patients divided into three groups of 25 each. In the first group, we used the Veress needle technique in the umbilicus. In the second group, the insertion was in the upper left quadrant, and in the third group the insertion was direct with a disposable trocar in the umbilicus without pneumoperitoneum. In the first group, we made 32 attempts, and the time varied from 8 to 35 min. In the second group we made 28 attempts and the time was from 3 to 6 min. In both we had complications. In the third group, we made 25 direct insertions without complications, and the time was from 45 s to 3 min.

Adolescent↗
PubMed1995

Tumor embolism after pneumonectomy for primary pulmonary neoplasia.

We report a case of tumor embolism of the lower right extremity after right pneumonectomy. This is an infrequent complication and in most cases occurs during the intraoperative or immediate postoperative period. Our patient underwent surgery for primary pulmonary neoplasia (squamous cell carcinoma) and 4 hours later showed clinical signs of acute arterial occlusion in the lower right extremity. An emergency embolectomy was performed and a thrombus with tumor characteristics was extracted from the right common femoral artery. The pathologic features of this thrombus were identical to those of the pulmonary tumor.

Aged↗
PubMed1991

Distribution kinetics of netilmicin in human blister fluid: effect of renal impairment.

The pharmacokinetics of netilmicin in plasma and blister fluid were compared in 10 healthy volunteers with normal renal function and 10 voluntary patients with varying degrees of renal impairment. Netilmicin kinetics in plasma were characterized by an open two-compartment kinetic model. For the study of the kinetics of the antibiotic in blister fluid a specific kinetic distribution model was employed. In the healthy volunteers the plasma kinetics of netilmicin showed a behaviour similar to that of other aminoglycoside antibiotics, although a high blister/plasma partition coefficient was obtained, with a mean value of 4.27 +/- 1.65. The transfer of netilmicin in blister fluid governed by the constants K1b/Vb and Kbl had mean values of 0.19 +/- 0.09 h-1 l-1 and 0.25 +/- 0.10 h-1, respectively. In the patients with renal impairment plasma and blister fluid antibiotic levels showed a progressive accumulation. In these patients the affinity of netilmicin for blister fluid was significantly altered. The blister/plasma partition coefficient in this group of patients had a mean value of 2.65 +/- 1.33; the decrease being statistically significant (p = 0.023) with respect to the value obtained in the healthy volunteers. Similarly, the exit constant of netilmicin from blister fluid (Kb1) showed a statistically significant increase (p = 0.035) in the patients with renal impairment. The findings point to a loss of affinity of netilmicin for blister fluid as a result of renal impairment. Linear and logarithmic relationships were established between some pharmacokinetic parameters and creatinine clearance. Dosage schedules are proposed for netilmicin in patients with renal impairment.

Adult↗
PubMedDate not supplied

Ceforanide pharmacokinetics in haemodialysis: the effect of ultrafiltration.

The kinetics of ceforanide in plasma and dialysate was studied in 8 patients with terminal renal impairment after undergoing haemodialysis sessions lasting between 4 and 5 h. All patients received a single i.v. dose of 15 mg kg-1 of the drug at the start of the session. The dialysers used in this study were Spiraflow capillar 1.3 m2, Travenol plates 1.4 m2, and PAN plates. Blood flow ranged between 200 and 300 ml min-1 and dialysate flow between 500-650 ml min-1. Plasma ceforanide levels were measured at the input and output of the dialyser and the antibiotic levels in dialysate were determined coinciding with the withdrawal times of the blood samples. A microbiologic plate diffusion method was used to determine the antibiotic concentrations. The mean values of some pharmacokinetic parameters of ceforanide calculated with a non-linear regression program from the data obtained from arterial blood were the following: alpha (h-1) = 4.14 +/- 1.32; beta (h-1) = 0.26 +/- 0.07; t1/2 beta (h) = 2.82 +/- 0.82; Vdss (1) = 10.24 +/- 2.14. From the relationships between the antibiotic concentrations at the input and output of the dialyser it was possible to calculate an extraction coefficient of 0.11 +/- 0.06. The dialysis clearance of ceforanide was calculated from the determination of the extraction coefficient and from the measuring of antibiotic in dialysate, though different results were obtained with the two methods. Dialysis clearance calculated from the extraction coefficient showed a mean value of 18.68 +/- 12.16 ml min-1, significantly lower (p less than 0.01) than that established by analysis of the antibiotic in dialysate, which was 41.55 +/- 15.83 ml min-1. These differences may be attributed to problems related to the determination of blood flow and to the ultrafiltration capacity of the dialysis membranes. A linear relationship was established between the percentage error in the observed and predicted extraction coefficients and the ultrafiltration rate. The results obtained suggest that the simultaneous measurement of the antibiotic in plasma and dialysate is the most suitable method for predicting the dialysis clearance of the drug. The amount of antibiotic extracted over a 4-hour dialysis session proved to be equal to 57.85 +/- 15.62 per cent of the dose administered.

Adult↗
PubMedDate not supplied

[Comparative study of the efficacy and tolerance of cetirizine verses astemizole in patients with allergic rhinitis].

Thirty four patients with allergic rhinitis were included in two randomized groups and treated with Cetirizine and Astemizole respectively, 10 mg/day in oral administration during 15 days. This study was designed in order to compare the efficacy and tolerance of Cetirizine versus Astemizole, with special reference on the collateral effects on the central nervous system. Although both drugs showed good results. Cetirizine had a statistically significant better outcome in the evolution of symptoms, above all at the second day of treatment. Also it showed superior results, based on a subjective approach, related to the rapidity, power and efficacy of its action.

Adult↗