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Biomedical subjects

K Gutierrez

Publications and source records attributed to K Gutierrez.

At least 19 recordsLinked to original sources
PubMed2001

Natural history of neonatal herpes simplex virus infections in the acyclovir era.

OBJECTIVE: During the 2 decades in which effective antiviral therapies have been available for neonatal herpes simplex virus (HSV) disease, changes have been documented not only in the outcomes of infected infants, but also in the natural history of the disease itself. Numerous studies previously have reported that early institution of antiviral therapy is beneficial to the outcome of the disease. The objective of this study was to provide an update of neonatal HSV disease to identify means by which future improvements in the management of HSV-infected neonates can be made. DESIGN/METHODS: Neonates enrolled in 2 studies of parenteral acyclovir for the treatment of neonatal HSV disease provided the data source. The National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group conducted the studies between 1981 and 1997. A total of 186 patients are summarized, all of whom were treated with acyclovir. Demographic and clinical characteristics of these patients are reported. RESULTS: Comparisons between patients treated in the periods between 1981-1988 and 1989-1997 according to extent of disease revealed that the mean time between the onset of disease symptoms and initiation of therapy has not changed significantly from the early 1980s to the late 1990s. Of all patients evaluated, 40% had fetal scalp monitors during the delivery process. A significant minority of patients did not have skin vesicles at the time of their presentation and did not develop them during the acute HSV disease (39% of patients with disseminated disease; 32% of patients with central nervous system [CNS] disease; and 17% of patients with skin, eye, and/or mouth disease). Among patients with CNS disease, mortality was associated with prematurity. Among patients with disseminated HSV disease treated with acyclovir at 30 mg/kg/d, mortality was associated with aspartate transaminase elevations of >/=10 times the upper limit of normal at the time of initiation of acyclovir therapy. Mortality was also associated with lethargy at initiation of antiviral therapy for patients with disseminated disease. Patients' morbidity status was associated with the extent of disease (skin, eye, and/or mouth disease vs CNS vs disseminated). For those patients with CNS disease, morbidity was also associated with seizures at initiation of antiviral therapy. CONCLUSION: Data presented in the current comparison of neonatal HSV disease over the 2 periods (1981-1988 vs 1989-1997) demonstrate that no progress has been made in decreasing the interval between onset of HSV symptoms and initiation of antiviral therapy. Additional strides in the improvement of disease outcome may occur only if the interval between onset of symptoms and initiation of therapy is shortened. The means by which this will be accomplished lie in increased consideration of neonatal HSV infections in acutely ill infants. Specific data and recommendations to facilitate this goal are contained within.

Acyclovir↗
PubMed2001

Safety and efficacy of high-dose intravenous acyclovir in the management of neonatal herpes simplex virus infections.

OBJECTIVE: The objective of this investigation was to establish the safety of high-dose (HD) acyclovir for the treatment of neonatal herpes simplex virus (HSV) disease. In addition, an estimate of therapeutic efficacy was sought, both with respect to mortality and to morbidity. Virologic efficacy of HD acyclovir was also assessed. PARTICIPANTS: Infants who were </=28 days old and whose disease was considered to be caused by HSV were enrolled in this study. Patients with central nervous system (CNS; N = 28) or disseminated (N = 41) HSV infection were offered participation in the trial. A small number of patients with HSV disease limited to the skin, eyes, or mouth (SEM; N = 10) or whose disease was clinically consistent with HSV but who did not have virologic confirmation of infection (N = 9) also were enrolled on a compassionate basis. Only patients with virologically confirmed HSV disease were included in efficacy analyses. All enrolled patients were included in safety analyses. METHODS: The study was an open-label evaluation of intravenous acyclovir at dosages higher than the 30 mg/kg/d standard dosage approved by the US Food and Drug Administration. The first 16 patients enrolled received intermediate-dose (ID) acyclovir (45 mg/kg/d), and the next 72 patients received HD acyclovir (60 mg/kg/d). Acyclovir was administered in 3 divided daily doses for 21 days. Neonates were assessed prospectively throughout treatment and at scheduled follow-up visits for the first 4 years of life. Data were compared with those of a previous National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group trial in which patients received standard-dose (SD) acyclovir for 10 days and in which identical methods (with the exception of acyclovir dosage and duration of therapy) were used. RESULTS: Six (21%) of 29 HD acyclovir recipients whose HSV disease remained localized to the SEM or CNS experienced neutropenia. One of the 6 had an absolute neutrophil count <500/mm(3), and 5 patients had an absolute neutrophil count (ANC) between 500/mm(3) and 1000/mm(3). In all 6 cases, the ANC recovered during continuation of acyclovir at the same dosage or after completion of acyclovir therapy, and there were no apparent adverse sequelae of the transient neutropenia. No other drug-related adverse events were reported among ID or HD recipients, and no other laboratory aberrations could be correlated specifically with antiviral therapy. The survival rate for the patients with disseminated HSV disease treated with HD acyclovir was significantly higher than for those in the previous study treated with SD acyclovir, with an odds ratio (OR) of 3.3 (95% confidence interval [CI]: 1.4-7.9). For patients with CNS disease, however, survival rates were similar for the HD and SD groups. To assess the effect of HD acyclovir on survival for the entire population with neonatal HSV disease, the Cox proportional hazards regression analysis was performed with stratification for disease category (CNS versus disseminated). In performing this analysis, differences in mortality for each disease category were weighted to allow statistical comparison of the treatment dosage groups (HD, ID, and SD). This analysis indicated that the survival rate for patients treated with HD acyclovir was statistically significantly higher than for patients treated with SD acyclovir (OR: 3.3; 95% CI: 1.5-7.3). Recipients of HD acyclovir had a borderline significant decrease in morbidity compared with SD recipients, after stratification for the extent of disease (SEM vs CNS vs disseminated) and controlling for the potential confounding factors of HSV type (HSV-1 vs. HSV-2), prematurity, and disease severity (seizures). Patients treated with HD acyclovir were 6.6 times (adjusted OR; 95% CI: 0.8-113.6) as likely to be developmentally normal at 12 months of age as patients treated with SD therapy. CONCLUSION: These data support the use of a 21-day course of HD (60 mg/kg/d) intravenous acyclovir to treat neonatal CNS and disseminated HSV disease. Throughout the course of HD acyclovir therapy, serial ANC determination should be made at least twice weekly. Decreasing the acyclovir dosage or administering granulocyte colony-stimulating factor should be considered if the ANC remains below 500/mm(3) for a prolonged period.

Acyclovir↗
PubMed2001

[Management of hallucinating patients].

Hallucinations are perceptions lacking any extern or physical stimulus. They can affect all senses and may occur in the course of different physical or psychiatric diseases. Patients experiencing hallucinations may derive the conviction that the contents of their hallucinations and the consequent interpretations are real, therefore they may try to convince their relatives and friends. Thus it has proved helpful to follow certain rules in the treatment of these patients. It is important not only to diagnose the basic disorder or illness but also to deal with the patient's anxiety, respect his/her perceptions and to try to establish alternative models of explanation. Apart from therapy of the underlying disorder it is wise to recommend psychotherapy and the attendance of self-help groups.

Antipsychotic Agents↗
PubMed2000

Strategies for an effective youth counter-marketing program: recommendations from commercial marketing experts.

Intensive and sustained efforts to "counter-market" tobacco among teenagers are necessary to negate the "friendly familiarity" created by tobacco advertising and to communicate the true health and social costs of tobacco use. Counter-marketing campaigns should: highlight a tobacco-free lifestyle as the majority lifestyle of diverse and interesting individuals; explain the dangers of tobacco in a personal, emotional way; offer youth empowerment and control; use multiple voices, strategies, and executions; offer constructive alternatives to tobacco use; and portray smoking as unacceptable and undesirable for everyone. Counter-marketing activities should work in concert with other interventions to alter social norms regarding tobacco.

Adolescent↗
PubMed2000

Prison suicides in Austria, 1975-1997.

Suicide prevention in custody is hampered by the lack of funds and professional staff. In order to evaluate the prison suicide phenomenon, a study was conducted evaluating all suicides that occurred in Austrian prisons between 1975 and 1997 (n = 220). In addition to evaluating the number of male versus female suicides, the preferred suicide methods were studied, as well as suicide risk of different circumstances of custody. Suicide rates of distinguishable, important subgroups of prisoners were calculated. The suicide rate for prisoners on remand was 236.0 per 100,000, and for offenders classified as mentally ill it was 205.4 per 100,000. That is about 8 times higher than the suicide rate in Austria's general population (1975-1997: 24.6 per 100,000). The suicide rate for sentenced offenders was 81.3 per 100,000, about twice the suicide rate in Austria's general male population. We recommend that psychologists or psychiatrists concentrate on the suicide prevention of high-risk offenders after screening the newly admitted offenders for their propensity to suicide.

Austria↗
PubMed1999

Sadistic personality disorder in sex offenders: relationship to antisocial personality disorder and sexual sadism.

To investigate the relationship of sadistic personality disorder (SPD), as defined in the appendix of DSM-III-R, to other personality disorders and to sexual sadism, 70 sex offenders (27 child molesters, 33 rapists, and 10 murderers) were assessed by the International Personality Disorder Examination. In 19 subjects (27.2%) from the total sample, SPD was diagnosed. The highest overlap appeared with borderline personality disorder (31.6%) and antisocial personality disorder (42.1%). However, in four cases SPD was the only personality disorder diagnosed. Factor analysis of the antisocial and sadistic criteria resulted in four major factors--one factor with high loadings on the sadistic criteria and the violent criteria of antisocial personality disorder, two factors with different forms of adult and juvenile aggression, and a fourth factor with high loadings on the antisocial criteria covering exploitative behavior. The results do not support SPD as a discrete disorder. Nevertheless, SPD may be seen as an important subdimension of antisocial personality disorder, distinct from more exploitative forms of antisocial behavior with less violence. Of those patients with SPD, 42.1% also had a DSM-III-R diagnosis of sexual sadism, which may be the most dangerous configuration.

Adult↗
PubMed1998

The relevance of self-concepts discriminating in long-term incarcerated sex offenders.

Lack of self-esteem and assertiveness have been thought to play an important role in the etiology and maintenance of sex offending behavior and to be significantly related to the number of previous convictions or violence of the assault. We, therefore, analysed self-concepts of 53 long-term incarcerated sex offenders to research the correlation between concepts of self-esteem, assertiveness, feelings towards others and relationships and the degree of violence of the last offense and risk of reoffense. We also investigated the relationship of previous convictions and duration of incarceration with the offenders' self-concepts and the influence of psychotherapeutic intervention on the offenders' self-concepts.

Adult↗
PubMed1998

[Differential depression and organic disorder diagnosis and their possible treatments].

This paper deals with an important differential diagnosis of depression. While mood disorders are more and more subclassified in present days, the clinically very similar psychopathological pictures, produced by "disturbances due to a general medical condition" (DSM-IV) evokes less and less interest. Misdiagnosis may lead to antidepressant therapy, which will not be well tolerated by the patient. Therefore the symptomatology of acute and chronic, diffuse and localized brain disturbances is outlined for easy clinical use.

Antidepressive Agents↗
PubMed1997

[Sex offenders in legal treatment and their relatives: results of family therapy sessions].

Members of the family of origin and spouses have been invited to take part in a cognitive-behavioral treatment programme for incarcerated sexual offenders to support the offender. Offenders arranged appointments with their spouses, mother, fathers and the therapist. A one-year follow-up reveals considerable change in denying and minimisation of responsibility, forcefullness and degree of sexual intrusiveness of both the offenders and the spouses. Both groups showed a better understanding for and a more positive attitude to the offenders' sexuality. Furthermore, both groups showed a significant increase in applying concepts of relapse prevention.

Adult↗
PubMed1997

[Driver's license expertise and psychiatric diagnosis. An analysis of 712 specialist expert assessments].

In a large University Department of Psychiatry a retrospective analysis of 712 psychiatric expertises on fitness to drive was carried out to identify factors influencing the decision "unfit to drive". Psychological test results were identified as the most potent factors influencing this decision, whereas a psychiatric diagnosis seems to be less important. The results indicate that demographic data and history (previous psychiatric hospitalisations, previous verdict "unfit to drive") were not influential. It is concluded that today's psychiatrists, when carrying out expertises on the question of fitness to drive, do not follow previous recommendations of placing a verdict of "unfit to drive" on all persons with a psychiatric diagnosis. They obviously follow a more individualised and pragmatic approach.

Alcoholism↗
PubMed1996

Continuation of antibiotic therapy for serious bacterial infections outside of the hospital.

Many children hospitalized with serious bacterial infections are candidates for either home oral antibiotic therapy or outpatient parenteral antibiotic therapy. Outpatient antibiotic therapy offers the potential for excellent medical treatment, reduced costs, and improved quality of life for ill children. However, cost considerations must not override good medical judgment. Certain children simply are not candidates for outpatient therapy because of the seriousness of their infection, poor compliance, lack of intravenous access, or poor social situation. In addition, although the few published studies to date all show that outpatient antibiotic therapy is effective, there is further need for properly designed clinical trials to evaluate the efficacy and safety of outpatient antibiotic therapy for serious bacterial infections in children.

Ambulatory Care↗
PubMed1993

Collaborative learning partnership creates the perinatal nurse practitioner.

A Jesuit university and a large medical center in the Rocky Mountain region combined talents and resources in response to a community need to develop a new practitioner program. Together, the university and the medical center created what neither one alone could have: the perinatal nurse practitioner (PNNP) program. At the time it was developed it was the first of its kind in the country. The collaborative relationship, the PNNP role, and the curriculum are described.

Academic Medical Centers↗
PubMed1989

Perioperative nursing in the college curriculum. A custom fit.

Although this course is in its infancy, it has become popular among baccalaureate students. Incoming junior students are enthusiastic about an elective course that provides them an opportunity to focus on an aspect of nursing that is no longer available to them in most nursing programs. The morale of the operating room nursing staff, particularly among the preceptors, has increased tenfold. In an era of nursing shortages, creative and innovative methods of recruiting students and retaining experienced nurses in all fields are vital. This unique course may be one of those methods. It is widely known that high morale yields a more productive work environment, lower turnover, and a cohesive work force that provides high quality nursing care in a most cost-effective manner.

Curriculum↗