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M Cuenca

Publications and source records attributed to M Cuenca.

11 recordsLinked to original sources
PubMed1997

Focal infections due to non-typhi Salmonella in patients with AIDS: report of 10 cases and review.

Bacteremia due to non-typhi Salmonella is frequent in human immunodeficiency virus (HIV)-infected patients; however, focal complications rarely have been reported. Ten of 38 HIV-infected patients (26.3%) with salmonellosis documented over a period of 9 years had focal suppurative complications; only 19 (3.9%) of 490 adults without HIV infection who were seen during the same period had focal complications (P = .001). Infections of the urinary tract, lungs, and soft tissue, followed by arthritis, endocarditis, and meningitis were most frequently seen. Although salmonellosis occasionally heralded HIV infection, most patients were severely immunocompromised and had CD4 cell counts of <100/mm3. The mortality rate was 50%, equivalent to that observed among patients with other immunosuppressive disorders (52.6%). Major emphasis must be put on intensive therapy for salmonella bacteremia and prevention of its complications.

AIDS-Related Opportunistic Infections↗
PubMed1997

Effect of pH and buffer system on the in-vitro activity of five antifungals against yeasts.

We have compared the effect of various media on the in-vitro activity of amphotericin B, flucytosine, fluconazole, itraconazole and ketoconazole against 93 clinical yeast isolates by a micro-broth dilution technique. The media used were: RPMI 1640 with 2% glucose, buffered with 0.165 M MOPS at pH 7.0; the same medium, but buffered at pH 7.4; and the same medium, but buffered at pH 7.4 with 0.15% sodium bicarbonate. The three media gave similar results with azole antifungals and flucytosine, but the medium buffered at pH 7.0 failed to detect different populations of yeasts with respect to amphotericin B susceptibility. In the case of the media buffered at pH 7.4, Candida krusei was significantly less susceptible to amphotericin B than Candida albicans or Torulopsis glabrata. We could not evaluate the results obtained with Candida parapsilosis and Cryptococcus neoformans since these species did not grow adequately in all three media.

Amphotericin B↗
PubMed1997

[Spontaneous meningitis caused by gram-negative bacilli].

OBJECTIVE: To analyze the causative factors, clinical and microbiological characteristics, and prognosis in spontaneous meningitis caused by Gram-negative rods in adult patients. METHODS: Descriptive and retrospective study of all clinical records and microbiological findings in patients diagnosed of meningitis by Gram-negative bacilli, from 1973 to 1995, at Fundación Jiménez Díaz. RESULTS: Twenty patients had spontaneous meningitis caused by Gram-negative bacilli (2.1% of all diagnosed meningitis during this period). Fourteen patients were older than 65 years (range: 36-81; p < 0.05). Ninety-five percent of cases had an extranosocomial origin (p < 0.001). Ninety percent of patients had some underlying disease (p < 0.001). Twelve patients were immunosuppressed. Seven patients had changes in the urinary tract or repeated UTI infections. The most common clinical symptoms were a decrease in consciousness level, fever, and neck stiffness. Cerebrospinal fluid (CSF) in 18 patients showed cellular and biochemical changes. The CSF smear revealed the presence of Gram-negative bacilli in 15 patients. E. coli was the microorganism recovered most frequently. Immunosuppression (p < 0.05), septic shock (p < 0.001) and antimicrobial therapy not including a third generation cephalosporin (p < 0.01) were independently associated with mortality. CONCLUSIONS: Spontaneous meningitis by Gram-negative bacilli is an uncommon infection. It occurs mainly in immunosuppressed patients older than 65 years or with changes in the urinary tract. It usually has an extranosocomial origin. The investigation of CSF is a highly effective for diagnosis. Therapy with third generation cephalosporins has notably improved its prognosis.

Adult↗
PubMed1995

Bronchoalveolar lavage for the diagnosis of disseminated toxoplasmosis in AIDS patients.

The usefulness of cell culture of bronchoalveolar lavage fluid for the diagnosis of toxoplasmosis in immunocompromised hosts has not been stressed previously. We report an acquired immunodeficiency syndrome patient with disseminated toxoplasmosis who was diagnosed by isolation of Toxoplasma gondii in cell cultures from bronchoalveolar lavage fluid.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

[Endotrachael aspiration protocol in patients with serious cranial trauma. study of neurophysiological variables].

Aspiration of tracheobronchial secretions can cause noxious effects on neurophysiological variables. Different studies that refer to aspiration of secretions in Serious Cranial Trauma use hyperinsuflation and hyperoxygenation to minimize its repercussion on Intracranial Pressure and thus try to not contribute to the secondary lesion. After reviewing these studies, a protocol of tracheobronchial secretion aspiration was performed in our ICU in patients with serious cranial trauma subjected to mechanical ventilation in order to assess the effect of the aspiration of secretions in the neurophysiological variables following homogeneous and standardized guidelines. Neurological, hemodynamic, oxygenation and ventilation variables were analyzed before, during and after aspiration of secretions. When the results were compared before and during this, we observed a decrease in the Intracranial Pressure with increase of Cerebral Perfusion Pressure (due to increase of Mean Blood Pressure), maintaining the levels of PaCO2 and jugular saturation of O2, with an increase in the airway pressures. After finishing the aspiration process, all the affected values recovered. It is concluded that the aspiration of tracheobronchial secretions in patients with Severe Cranial Trauma, after standardized hyperinsuflation and hyperoxygenation, does not alter the hydrodynamics or brain use of O2.

Adult↗
PubMedDate not supplied

[Analysis of the situation of intensive care units].

Since 1990, the Sociedad Española de Enfermería Intensiva y Unidades Coronarias has carried out initiatives aiming to collect data which allows us to make an analysis of the status of the ICU nurses and the characteristics of the Units where these professionals develop their activity. This project was performed during 1992 and 1993, with a survey in 132 sanitary centres of the public network in the national territory, in which information about the number of ICUs and their number of beds, number of nurses and assistants in the institution and those ones specifically assigned to ICU, number of admissions, average stay, occupation percentage, admission causes, use of systems of valuation of the seriousness index, staff seniority, shift systems, staff stability, etc; all this data and others referring to 1991. From 53 hospitalary centres that answered the questionnaire, we obtained information of 94 ICUs in which there was an average of 10.4 beds, with 550 admissions per unit (average/year) and an index of occupation of 78%. The average number of nurses who work in each ICU was 22.7, with a nurse/bed ratio in the global calculation of staff of 2.18. In the analysis of shifts, the nurse/bed ratio was one nurse to every 2.08 patients (1:2.08) when there is a maximum of staff during the morning shift. This index is lower in the other shifts. The average of assistants is 12.1 with an assistant/bed ratio of 1.17. When studying the shifts systems, the rotatory shift outstands in 53.19% of ICUs and the existence of rotation systems of staff in other units is 8.5%. With reference to the characteristics of the staff, the average seniority of Nurses was 6.7 years, 76.4% have own their post and the percentage of new intake in 1991 was 22.5%. The lack of incentives to work in ICU is notable, the most problematic aspects being the insufficient economic remuneration, lack of motivation, scarce human resources and insufficient training, among others. Finally, according to the teaching and research activity performed in the units, 5.4% of ICUs have a nurse in the unit with exclusive dedication to teaching, in 20.4% there are nurses who keep a contractual relationship with University Nursing Schools, in 42.6% of the units there are training programs for the new staff and 67% perform some sort of research activity although in most of the cases it is only sporadic.

Adult↗
PubMedDate not supplied

[Certification of professional competence in critical care. Opinion survey].

This article gathers the results and conclusions derived from a survey performed by the Work Group of the SEEIUC dedicated to the development of the Professional Certificate in Intensive Care. The survey was carried out with the aim of obtaining the opinion of nursing professionals who work in Intensive Care Units, about the training and requirements which are necessary to work in these units. The questionnaires were sent to all the members of the SEEIUC and to a great number of mixed, surgical, trauma and coronary ICUs all over the country. Among the opinions which were collected, the following ones must be pointed out: specific nursing knowledgement is necessary to work in Intensive Care; experience is essential to acquire confidence and good command of the job; nursing professionals need mechanisms which help their professional development; and the Certificate Programme is accepted as a valid system which certificates professional competence.

Attitude of Health Personnel↗
PubMedDate not supplied

[Program for nursing certification in critical care].

This article presents the Nursing Certification Program in Critical Care through which the Spanish Society of Intensive Nursing and Coronary Units (SEEIUC) accredits, by means of a diploma, the professional competence of graduate nurses in the care of critically ill patients. The program describes the system of certification and focuses on the study material for the examination, which is grouped into eleven thematic units. The first exam will be held 10 June 1999 in Palma de Mallorca, coinciding with the XXV National Congress of the SEEIUC.

Certification↗