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O Fernández Alvarez

Publications and source records attributed to O Fernández Alvarez.

13 recordsLinked to original sources
PubMed2001

[Prognostic factors of bacteremia: prospective study].

BACKGROUND: To identify the epidemiology and risk factors with influence in the outcome and mortality of a series of bacteriemic patients. MATERIAL AND METHODS: A prospective study of bloodstream infections with clinical significance detected in a secondary hospital of 650 beds over period from May 1998 to May 1999. The true bacteriemia was defined in basis to the criteria both the physician and microbiologist. A total of 16 variables were defined and categorized such as clinical-epidemiologic, intrinsic risk factor, extrinsic risk factor, outcome and survival. We used SPSS statistical package: For cuantitative variables we carried out with the mean with confidence interval of 95%, for cualitative variables: number and %. Univariate analysis of the results was carried out with the X2 test and t Student, the survival was expressed with Kaplan Meyer graphics and the logistic regression model. RESULTS: A total of 320 positive blood cultures were studied but only 272 blood cultures were considered true bacteriemia in 259 patients. The calculated incidence of significant episodes of bacteriemia per 1000 admissions/year was 13. The overall mortality was 22% whereas death attributable to bacteriemia was 16%. The mean age was 66.9 years (IC 95% 65-69), 59% episodes occurred in men. The 78% episodes occurred in patients hospitalized in medical services. 52% episodes were of nosocomial infection and 48% of community acquired infection. According to the severity of the underlying disease, 15% had fatal diseases and 35% episodes occurred in patients without underlying disease. According to the univariant analysis, the variables which where significantly associated with greater risk death were: etiology (fungus), septic shock, the inadequate antibiotic therapy, presence of extrinsic factors (central intravenous catheter, performance of invasive procedures, previous antimicrobial therapy) and the hospital stay of less than 10 days. According to the multivariable analysis showed that the factors remaining independent predictors of mortality were: septic shock (p < 0.0001, OR: 8), inadequate antimicrobial therapy (p < 0.005, OR: 6.7), existence of two or more extrinsic risk factors (p < 0.04). CONCLUSIONS: The presence of septic shock was the most important variable which influenced in the mortality in our serie, together with inappropriate antimicrobian therapy and the association of various extrinsic risk factors. These variables could be modified partly, for this reason the aggressive hemodynamic control and the early and appropriate antibiotic therapy would be the support of the successful bacteriemia management.

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[Medullary carcinoma of the thyroid. Familial variety].

A patient who consulted because of diarrhea was diagnosed of thyroid medullar carcinoma (TMC) associated to pheochromocytoma. All members of his family were studied for a possible family variety of TMC with a genetic origin. In the 21 family members studied basal and calcium-pentagastrin stimulated calcitonin levels were determined and parathyroid and adrenal gland function were explored to rule out pheochromocytoma. Elevated levels of calcitonin agreed with pathological findings of TMC. Pheochromocytoma carriers had altered catecholamines and an abnormal abdominal CT scan. The clinical, analytical and radiologic findings in the four affected family members are described. The histopathological study revealed a pheochromocytoma in one case and bilateral TMC in two cases. The cytology of aspiration biopsy samples was positive for TMC in three cases. The importance of calcitonin determinations is emphasized as well as the obligatory determination of catecholamines and adrenal CT scan in order to rule out the coexistance of pheochromocytoma. The reasons for not utilizing gammagraphy with meta-iodine benzyl guanidine in these four cases are also explained.

Adrenal Gland Neoplasms↗