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L Salinas

Publications and source records attributed to L Salinas.

13 recordsLinked to original sources
PubMed1992

Nosocomial transmission of tuberculosis in a hospital unit for HIV-infected patients.

OBJECTIVE: To assess nosocomial transmission of tuberculosis (TB). DESIGN: A historical cohort study of hospitalized patients with the human immunodeficiency virus (HIV) and a purified protein derivative (PPD) tuberculin skin test survey of health care workers (HCWs). SETTING: A large public teaching hospital in San Juan, Puerto Rico. PATIENTS: For the cohort study, a case patient was defined as any patient in the HIV unit at the hospital who developed culture-positive TB from 31 days or more after admission through December 31, 1989. For the PPD survey, of 1420 HCWs from the hospital, 908 agreed to participate and had sufficient data for analysis. MAIN OUTCOME MEASURES: For the cohort study, to compare the risk of developing active TB among patients who were exposed to hospital roommates with infectious TB and the risk among nonexposed patients. For the HCW PPD survey, to determine the prevalence of and risk factors for tuberculous infection. RESULTS: Eight of 48 (9.7/10,000 person-days) exposed case patients vs four of 192 (0.8/10,000 person-days) nonexposed case patients developed active TB (relative risk [RR] = 11; 95% confidence interval [CI], 2.3, 50.3). Positive PPDs (greater than or equal to 10 mm of induration) in HCWs were associated with older age (P = .0001) and with history of community TB exposure (P = .0002). In a multivariable logistic model that adjusted for these variables, HIV unit nurses (nine of 19) and nurses in the internal medicine ward (45 of 90) had a higher proportion of positive PPDs than the reference group (clerical personnel on other floors: 35 of 188, P = .0005). CONCLUSIONS: These data suggest that patient-to-patient transmission of TB in HIV units can occur and that HCWs are at risk of acquiring TB infection.

Adolescent↗
PubMedDate not supplied

[Glomerulonephritis following an infected ventriculoatrial shunt. Report of 2 cases].

Two patients with shunt nephritis are reported. One of the patients had a positive blood culture to Staphylococcus albus; the kidney biopsy showed an immune complex disease. In the second patient, Klebsiella sp., was cultured in the blood, and this is the first report with such bacteria as the cause of nephritis. The finding of fibrin in the glomeruli by light, immunofluorescence and electron microsocopy studies, suggests a pathogenesis different from intravascular coagulation. In both patients, nephritis became inactive when the shunt was removed.

Cerebrospinal Fluid Shunts↗
PubMedDate not supplied

Treatment of presumed bacterial pneumonia in ambulatory children.

In a prospective, randomized, open study, a combination of trimethoprim and rifampin (TMP/R) 20 mg/kg/day was compared with ampicillin (AMP) 150 mg/kg/day, both given orally twice daily for 10 days, for the treatment of 60 children who had mild community-acquired pneumonia. The control group comprised 112 healthy children. The overall duration of the disease was 8.5 +/- 3.6 days in the TMP/R group vs 6.0 +/- 1.1 days in the AMP group. Fever persisted for 7.0 +/- 1.8 days in the TMP/R-treated patients vs 5.2 +/- 1.0 days in the AMP-treated patients. At the end of the 10 days, nasopharyngeal cultures were negative in all patients in the AMP group and in 25 of the 30 patients in the TMP/R group. These five patients were clinical and microbiologic failures. We conclude that in infants and children with mild community-acquired pneumonia, treatment with AMP for 10 days is more effective than treatment with a combination of TMP/R for clinical cure and eradication of bacterial pathogens.

Ampicillin↗
PubMedDate not supplied

[Rheumatic carditis in the adult. Anatomoclinical correlation].

The histologic findings of 325 necropsies of rheumatic patients at the National Institute of Cardiology in Mexico, between 1980-1985 were studied forty five of them had Aschoff nodules plus valvular inflammation-Out of these 45 cases two groups were formed: children-adolescent group (24 cases) and an adult group (21 cases). The clinical, histologic and laboratory findings were compared. Clinical records were reviewed searching for history of rheumatic fever. Active rheumatic fever was suspected in 16 patients in the younger group (67%) and only in 3 adults (14.2%). As far as Jones' criteria is concerned, the most common finding was carditis, principally in the younger group (83%). In the adult group, it appeared in 50% of the patients. All other criteria were only occasionally seen or could not be identified during the patients lifetime. The most common laboratory finding which could suggest active rheumatic fever were: a high levels of anti-streptolysin in younger patients (95%) and elevation of erythro-sedimentation in adults (83%). We conclude that in active rheumatic fever of the adult; Jones criteria are not met, so the illness is difficult to recognize, and there is clinical-histologic discrepancy. In this context the disease has a "silent" evolution.

Adolescent↗
PubMedDate not supplied

Tuberculosis: an increasing problem among minorities in the United States.

Although the number of tuberculosis cases reported annually in the United States has decreased markedly during the past three and a half decades, the decrease among whites has been considerably greater than among nonwhites. As a result of this widening gap, nearly two-thirds of the cases reported in 1987 occurred in minority populations and, for the first time in history, the number of cases among blacks exceeded the number of cases among non-Hispanic whites. From 1985 to 1987, tuberculosis among blacks increased 6.3 percent and among Hispanics, by 12.7 percent, but it decreased 4.8 percent among non-Hispanic whites. Much of the increase appears attributable to tuberculosis occurring among persons infected with the human immunodeficiency virus (HIV). Although there are many obstacles to the elimination of the disease in minority populations, numerous strategies have been developed and are being implemented to address this situation.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Use of echocardiography in the diagnosis of atrial myxoma].

The experience at the National Institute of Cardiology with atrial myxoma from 1944 to 1980 is presented; twelve patients were diagnosed, 8 females and 4 males, their age varied from 14 to 66 years. The tumor was inside the left atrium (LA) in 10 patients and in the right atrium (RA) in two. The diagnosis was confirmed by surgery or postmortem study. The symptoms and physical examination simulated mitral stenosis in the cases with myxoma of the LA, and pulmonary stenosis and Ebstein's anomaly in the two cases with RA myxoma. Symptoms of atrioventricular occlusion or embolic accident occurred by 5 patients and 3 of them died. The tumor was a postmortem discovery in the first cases, the next ones were an operatory surprise and the last ones were diagnosed by echocardiography. The advent of this technic has been definitive, all 7 patients studied by this method were diagnosed; in one the catheterism was interpreted as mitral stenosis and in other, during this procedure, cardiac arrest developed. The surgical removal of the tumor was successful in the nine patients that were operated. A correct and early diagnosis as well as an urgent surgical approach are necessary. With echocardiographic demonstration of the tumor, one patient died while he was waiting for surgical treatment.

Adolescent↗
PubMedDate not supplied

[Rupture of the free wall of the heart as cause of death in acute myocardial infarct].

Twenty four cases with myocardial rupture among 259 patients with autopsy after death due to myocardial infarction, were compared with patients with acute myocardial infarction and death secondary to other causes. Myocardial rupture occured during the first 72 hours in 58% of the patients and all cases within the first five days. Two thirds of the patients were males and 46% were 70 years of age. There were 24 myocardial ruptures (9.5%). Previous history of arterial hypertension and un-remittent anginal pain were predisposing factors for rupture (p=0.05). Other previously reported bad prognostic factors such as persistent hipertension after acute infarction, severe exercise before infarction and history of Diabetes Mellitus were not statistically significant in this study. Ruptured myocardium was not influenced by a previous history of myocardial infarction, hospitalization delay in the C.C.U., administration of anticoagulants, digitalis or pressor amines. There was no significant difference among the groups compared in enzyme curves or magnitude of leucocytosis. Electromechanic dissociation, sinus bradycardia, nodal rhythm followed by idioventricular rhythm and asystole, were observed following myocardial rupture.

Acute Disease↗
PubMedDate not supplied

[Usefulness of echocardiography in the diagnosis of infectious endocarditis].

Thirty-four patients with clinical diagnosis of infective endocarditis were studied with M mode and/or two-dimensional echocardiography. of them. Twenty-two were men; their ages ranged from 9 to 67 years. In 23 cases surgical or post mortem confirmation of the echocardiographic diagnosis was obtained. The clinical features as well as history of previous cardiopathy (94.1%) and its type (congenital 38.2%, rheumatic 29.4%, rheumatic with valvular prosthesis 23.5%) were analyzed. In the 23 patients with proven endocarditis, the echocardiographic diagnosis was positive in 19 (82%); vegetations were evident in 13. In 6 patients vegetations were not found. There were 3 false positive cases and one false negative, giving a sensitivity of 0.81 and a specificity of 0.85. The causes of false negative and false positive findings were analyzed. These were closely related to the duration of the disease and time which elapsed between the echocardiographic study and confirmation in surgery or necropsy as well as the size of the vegetations. The echocardiographic diagnosis was difficult when a valvular prosthesis was present. Echocardiography is a useful technique for diagnosis and follow up of patients with infective endocarditis.

Adolescent↗
PubMedDate not supplied

[Disorders of the right intraventricular conduction in chronic pulmonary hypertensive cardiopathy].

Disorders of the right intraventricular conduction were analyzed in cases of chronic pulmonary hypertensive cardiopathy (C.P.H.C.), diagnosed on basis of the anatomic data. The series studied here (40 cases) was obtained from the review of 3,000 reports of autopsies at the Instituto Nacional de Cardiología de México. Thickness of the free right ventricular wall, thickness of the interventricular septum at three levels, thickness of Wolf's spur and the circumference of the 4 valvular rings, were determined in each heart. Haemodynamic studies and respiratory function tests were revised in those cases in which they had been practiced. Electrocardiographic study essentially analyzes the time of onset of intrinsicoid deflection as well as the morphology of ventricular complexes in the unipolar leads. In 37 cases (92.5%), a disturbance of the right intraventricular conduction was present. R.B.B.B. was observed in 29 cases (72.5%): 12 of minor degree, 19 of intermediate and 1 of advanced degree. Right peripheral block was diagnosed in 8 cases (20%): anterior type in 2 cases (5%); posterior type in 6 cases (15%). In the cases with R.B.B.B., the anatomic data of right ventricular hypertrophy were predominant; in those with R.A.S.B., anatomical data suggested right ventricular enlargement. The facts exposed here permit the following conclusions: 1) Diagnosis of right fascicular block can be suggested even in the presence of hypertrophy of the corresponding ventricle. 2) Hypertrophy of the right ventricle appears more directly related to the homolateral bundle branch block than to distal or segmentary blocks. 3) Topographic diagnosis of delay in the right ventricle activation process can be established by an electrocardiographic thoracic mapping that permits to explore the ventricular structures at different levels.

Adolescent↗
PubMedDate not supplied

[Pulmonary arterial hypertension in disorders of oxygen diffusion].

UNLABELLED: Twenty three cases with impairment of greater than 40% of DLCO were studied in a search of frequency, severity and pathophysiological mechanisms of PAH. Hemodinamic studies, pulmonary angiography (PA), lung scan (LS), lung biopsies (LB) were performed. The venous admixture was estimated and expressed as percentage ratio of the cardiac output (Qva/Qt x 100). Anatomical pulmonary artery to vein shunt (Qs/Qt) was estimated breathing pure O2. Ninety one percent of cases had PAH; mild to moderate in 76% of cases. Cardiac index (CI) was less than 2.8 in 26% and greater than 4.2 in 39%. The right ventricular work index (RVWI) was greater than 1.25 in 86%. The alveolar arterial oxygen tension gradient (A-aDO2) was abnormal in all cases (greater than 18 mmHg) with a Qva/Qt of greater than 30% in 78% of these cases. The Qs/Qt was found 6% in 39% of cases. IN CONCLUSION: PAH was mild to moderate in DL impairment. The RVWI was usually increased with a normal or high CI. Increase in Qva/Qt that result from V/Q abnormalities and extreme impairment of DL is to be considered as the major factor functional features in the genesis of PAH. Reduction of the cross sectional area of the pulmonary vascular bed and lung function abnormalities are equally important relevants features in the genesis of PAH.

Adult↗