Asunto(s)
Hemorragia/etiología , Leptospirosis/complicaciones , Enfermedades Pulmonares/etiología , Crianza de Animales Domésticos , Animales , Antibacterianos/uso terapéutico , Ceftriaxona/uso terapéutico , Claritromicina/uso terapéutico , Cuidados Críticos , Perros , Resultado Fatal , Hemoptisis/etiología , Hemorragia/diagnóstico por imagen , Humanos , Leptospira interrogans/aislamiento & purificación , Leptospirosis/diagnóstico por imagen , Leptospirosis/tratamiento farmacológico , Enfermedades Pulmonares/diagnóstico por imagen , Masculino , Metilprednisolona/uso terapéutico , Insuficiencia Multiorgánica , Óxido Nítrico/uso terapéutico , Enfermedades Profesionales , Radiografía , Adulto JovenRESUMEN
OBJECTIVE: Pseudomonas aeruginosa is a non-fermentative gram-negative bacillus with a great ability to develop resistance to multiple antibiotics, including carbapenems, which is a growing problem worldwide. The aim of this study was to analyse the prevalence of carbapenem-resistant P. aeruginosa (CRPA) in urine cultures and to determine the risk factors associated with the development of carbapanem resistance. METHODS: Positive urine cultures to P. aeruginosa between September 2012 and September 2014 were identified. We excluded repetitive cultures from the same patient. We created a database with different variables, including antimicrobial resistance. The prevalence of carbapenem resistance and the risk factors for growth of CRPA were analysed. RESULTS: Ninety-one patients with positive urine cultures to P. aeruginosa were included. The prevalence of CRPA was 22%. The risk factors to CRPA infection in the univariate analysis were: congestive heart failure (p=0.02), previous treatment with ampicillin (p=0.04), meropenem (p=0.04), piperacillin-tazobactam (p=0.01), trimethoprim-sulfamethoxazole (p= 0.01) and previous treatment with more than one antibiotic (p<0.01). Only congestive heart failure (p<0.01) and previous treatment with more than one antibiotic (p<0.01) showed statistically significant differences in the multivariate analysis. CONCLUSIONS: The prevalence of CRPA in urine cultures is high in our population. We should assess the presence of risk factors as previous treatment with more than one antibiotic or comorbidities such as heart failure, in order to select an appropriate empirical treatment in patients with severe urinary tract infections.
Asunto(s)
Carbapenémicos/farmacología , Carbapenémicos/uso terapéutico , Infecciones por Pseudomonas/tratamiento farmacológico , Pseudomonas aeruginosa/efectos de los fármacos , Orina/microbiología , Anciano , Anciano de 80 o más Años , Cardiomiopatía Dilatada/epidemiología , Farmacorresistencia Bacteriana , Femenino , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Prevalencia , Infecciones por Pseudomonas/epidemiología , Infecciones por Pseudomonas/microbiología , Factores de Riesgo , Infecciones Urinarias/tratamiento farmacológicoAsunto(s)
Antivirales/efectos adversos , Hepatitis C Crónica/tratamiento farmacológico , Interferón-alfa/efectos adversos , Polietilenglicoles/efectos adversos , Enfermedades de la Tiroides/inducido químicamente , Adulto , Anciano , Antivirales/uso terapéutico , Femenino , Humanos , Interferón alfa-2 , Interferón-alfa/uso terapéutico , Masculino , Persona de Mediana Edad , Polietilenglicoles/uso terapéutico , Proteínas Recombinantes/efectos adversos , Proteínas Recombinantes/uso terapéutico , Adulto JovenRESUMEN
The autoimmune hepatitis (AIH)-primary biliary cirrhosis (PBC) overlap syndrome is characterized for clinical, biochemical, immunological, and histological features overlapping those of AIH and PBC, whose pathogenesis and more appropriate treatment are unknown at present. We describe two new patients of this entity, which made debut with cholestasic acute hepatitis accompanied of hypergammaglobulinemia. In the first patient was demonstrated the presence of AMA, ASMA, and anti-LKM1 autoantibodies; and ANA in the second one. The histological findings showed changes suggestive of AIH and PBC. After the start of immunosuppressive treatment, associated to ursodeoxycholic acid in one patient, a successful outcome was observed.
Asunto(s)
Hepatitis Autoinmune/complicaciones , Cirrosis Hepática Biliar/complicaciones , Adulto , Anciano , Femenino , Hepatitis Autoinmune/diagnóstico , Humanos , Cirrosis Hepática Biliar/diagnósticoRESUMEN
INTRODUCTION AND OBJECTIVES: Dabigatran is an anticoagulant drug and a direct thrombin inhibitor and has been approved for the prevention of ischaemic stroke secondary to nonvalvularauricular auricular fibrillation. The aim of this study was to determine the efficacy of dabigatran in clinical practice for preventing cerebral ischaemic events associated with nonvalvularauricular auricular fibrillation, as well as its tolerance and safety profile. MATERIAL AND METHODS: A descriptive and retrospective study was conducted, which included all patients who started anticoagulant treatment with dabigatran between November 2011 and September 2012. Follow-up was performed from the start of treatment until June 2013. The incidence of ischaemic events of cerebral, cardiac and peripheral origin was recorded, as was the onset of adverse effects and haemorrhagic complications, whose location and severity were determined. RESULTS: We analysed 316 patients, with a mean age of 76.46±8.37 years, of whom 53.5% were men. Two patients (0.55/100 patient-years) presented ischaemic stroke (including one amaurosis fugax). Eight (2.18/100 patient-years) patients had an adverse ischaemic event, whose origin was cardiac in 5 (1.36/100 patient-years) cases and peripheral in 3 (0.81/100 patient-years). Forty (10.91/100 patient-years) patients had a haemorrhagic complication: 32 minor (8.73/100 patient-years) and 8 major (2.18/100 patient-years) haemorrhages. CONCLUSIONS: Dabigatran is effective in standard clinical practice in preventing stroke and has a safety profile similar to that reported in the clinical trials.
RESUMEN
Acute intermittent porphyria (AIP) is a rare condition characterized by abdominal pain and a wide range of nonspecific symptoms. We report the case of a woman with abdominal pain and syndrome of inappropriate antidiuretic hormone secretion (SIADH) as clinical presentation of AIP. The diagnosis was achieved through the etiologic study of the SIADH.
RESUMEN
We report one case of salmonellosis aortitis in a 70 years old man after an episode of gastroenteritis due to Salmonella enteritidis successfully resolved with extraanatomic by-pass and prolonged antibiotic administration.
Asunto(s)
Aortitis/etiología , Infecciones por Salmonella/complicaciones , Salmonella enteritidis , Anciano , Antiinfecciosos/uso terapéutico , Aneurisma de la Aorta Abdominal/complicaciones , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/cirugía , Aortitis/complicaciones , Aortitis/cirugía , Prótesis Vascular , Ciprofloxacina/uso terapéutico , Estudios de Seguimiento , Humanos , Masculino , Infecciones por Salmonella/tratamiento farmacológico , Factores de Tiempo , Tomografía Computarizada por Rayos XRESUMEN
We report the case of a cirrhotic patient with leukocytoclastic vasculitis who developed a rapid and progressive cellulitis with hemorrhagic bulla and sepsis due to Aeromonas hydrophila, the portal of entry was the surgical leech of a cutaneous biopsy.
Asunto(s)
Aeromonas hydrophila , Celulitis (Flemón)/microbiología , Infecciones por Bacterias Gramnegativas/diagnóstico , Celulitis (Flemón)/complicaciones , Infecciones por Bacterias Gramnegativas/complicaciones , Humanos , Cirrosis Hepática/complicaciones , Masculino , Persona de Mediana Edad , Vasculitis Leucocitoclástica Cutánea/complicacionesRESUMEN
We describe the case of a 70-years-old woman with ischemic-hemorrhagic lesions in the cutaneous surface of both feet and analytical data of disseminated intravascular coagulation, in which the studies conducted were negative except for the presence of cryofibrinogen in plasma. We also review the clinical manifestations and the diseases associated to cryofibrinogenemia previously described in the literature.
Asunto(s)
Coagulación Intravascular Diseminada/sangre , Fibrinógenos Anormales , Paraproteinemias , Anciano , Diagnóstico Diferencial , Coagulación Intravascular Diseminada/diagnóstico , Femenino , Pie/irrigación sanguínea , Humanos , Isquemia , Paraproteinemias/diagnóstico , Piel/irrigación sanguíneaRESUMEN
Seventeen cases of cerebral abscesses undergoing surgery were reviewed, underlying the characteristics of predisposing factors, infectious sources, microbiological and radiological studies, as well as clinical and evolutive aspects. The average age of the patients was 34 years, with a higher incidence in the second (35%) and sixth (22%) decades. The young patients (< 40 years) showed a greater frequency of adjacent infectious sources (83%) and the older patients (> 40 years), distant infectious sources (75%). The average time gap between the onset of symptoms and the diagnosis was 7 +/- 13 days. CAT showed in all the patients typical hypodense images with a peripheral ring; three patients had multiple abscesses and the remainder, single abscesses. In 12 patients (70.5%), microbiological cultures were positive, 3 (25%) for aerobe germs, 7 (50.3%) for anaerobe germs, 1 (8.33%) for multiple germs and 1 (8.33%) for fungi. Eleven patients underwent surgical drainage, four of which required latter exeresis. Six other patients underwent exeresis as the only surgical treatment. One patient died and the remainder showed a positive evolution. The hospital length of stay was 42.3 +/- 52.3 days. The most frequent sequela was the epilepsia present in 23.5% of the patients. Our findings are similar to the results of recent works, although in our series, there is a higher frequency of anaerobe germs. No differences were observed between the surgical techniques used nor between the past and current antibiotherapy patterns.
Asunto(s)
Absceso Encefálico/cirugía , Adolescente , Adulto , Anciano , Antibacterianos/uso terapéutico , Bacterias/aislamiento & purificación , Encéfalo/diagnóstico por imagen , Encéfalo/microbiología , Encéfalo/patología , Absceso Encefálico/diagnóstico , Absceso Encefálico/epidemiología , Absceso Encefálico/microbiología , Niño , Terapia Combinada , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , España/epidemiología , Tomografía Computarizada por Rayos XRESUMEN
A retrospective study of patients infected by Salmonella typhi (ST) was conducted in the southern area of Pontevedra during a 17-month period in order to assess the clinical and evolutive characteristics and the pattern of antibiotic susceptibility of the infection. ST was isolated from samples of 30 patients: 25 hemocultures, 7 coprocultores, 1 urine and 1 aortic aneurysm. Nineteen cases had consumed non-sanitary controlled water, 95% from rural areas. The clinical characteristics were similar to the ones traditionally described. Seven patients (23%) developed complications and their presence was associated to a poorer prognosis. We did not observe any resistance to the commonly used antibiotics. In summary, the infection by ST is still a health problem in our environment, probably associated to insufficient measures in the enloration of water for human consumption.
Asunto(s)
Fiebre Tifoidea/epidemiología , Adolescente , Adulto , Anciano , Niño , Farmacorresistencia Microbiana , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , España/epidemiología , Fiebre Tifoidea/tratamiento farmacológico , Fiebre Tifoidea/fisiopatologíaAsunto(s)
Antibacterianos/uso terapéutico , Piomiositis/tratamiento farmacológico , Piomiositis/microbiología , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/microbiología , Staphylococcus aureus , Teicoplanina/análogos & derivados , Diabetes Mellitus Tipo 2/complicaciones , Farmacorresistencia Bacteriana , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Teicoplanina/uso terapéuticoAsunto(s)
Exantema/etiología , Fiebre/etiología , Linfoma de Células B/diagnóstico , Anciano , Anticuerpos Monoclonales/administración & dosificación , Anticuerpos Monoclonales/uso terapéutico , Anticuerpos Monoclonales de Origen Murino , Antineoplásicos/administración & dosificación , Antineoplásicos/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Ciclofosfamida/administración & dosificación , Ciclofosfamida/uso terapéutico , Diagnóstico Diferencial , Doxorrubicina/administración & dosificación , Doxorrubicina/uso terapéutico , Exantema/diagnóstico , Fiebre/diagnóstico , Estudios de Seguimiento , Humanos , Inmunohistoquímica , Linfoma de Células B/complicaciones , Linfoma de Células B/diagnóstico por imagen , Linfoma de Células B/tratamiento farmacológico , Masculino , Prednisona/administración & dosificación , Prednisona/uso terapéutico , Radiografía Torácica , Rituximab , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Vincristina/administración & dosificación , Vincristina/uso terapéuticoRESUMEN
AIM: Cardiovascular disease (CV) is the second leading cause of morbidity and mortality in chronic obstructive pulmonary disease (COPD). Peripheral arterial disease (PAD) is associated with cardiovascular disease, and its risk factors are common to other atherosclerotic diseases. The objective is to determine the prevalence of PAD in a population of patients with COPD using the ankle / brachial index (ABI) and to investigate the relationship between PAD and lung disease severity. METHODS: In a prospective cross-sectional study, 246 patients with COPD were recruited. Patients were enrolled consecutively according to their admission to Povisa hospital from September 1, 2008, until March 1, 2010, and were assessed by clinical history, spirometry and ABI. The COPD severity was graded by GOLD criteria in spirometry. RESULTS: Overall, 84 patients (36.8%) had abnormal ABI results and 59 (70.2%) were asymptomatic for PAD. COPD patients with PAD had a higher prevalence of moderate to severe COPD (61.9% vs. 41.7%, P=0.004), lower mean forced expiratory volume in 1 second (FEV1) values (46.7% ± 15 vs. 52.3±14%, P=0.001) and a higher prevalence of hypertension (69% vs. 54.3%, P=0.03) and previous cardiovascular disease (34.5% vs. 21.3%, P=0.03). CONCLUSION: There was a high prevalence of asymptomatic PAD in the COPD patients we examined. Abnormal ABI results were associated with a higher prevalence of cardiovascular risk factors and more severe lung disease. The diagnosis of peripheral arterial disease in COPD is important because this is an entity that limits the patient's physical activity and impairs their quality of life in addition to turn it into a high cardiovascular risk patient that requiring additional therapeutic measures.