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1.
Seizure ; 112: 72-76, 2023 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-37769547

RESUMEN

INTRODUCTION: Highly purified cannabidiol (CBD) has a broad spectrum of action and could be useful for the treatment of drug resistant epilepsy regardless of etiology or syndrome. MATERIALS AND METHODS: Multicenter retrospective study that evaluated the efficacy and safety of CBD for the treatment of drug resistant epilepsy of different etiologies in patients >2 years of age. RESULTS: Seventy-eight patients with a median age of 24 years and a wide spectrum of mainly structural and genetic etiologies were included. Patients were using a median of 3 antiseizure drugs (IQR=2-4) and had a median of 30 monthly seizures (IQR=12-100) before starting CBD. The median treatment time with CBD was 14 months (IQR=10-17). The efficacy analysis at the last available visit showed that mean percent reduction in seizures, ≥50% reduction in seizure frequency and seizure freedom was 67.8%, 68.8% and 11.5% respectively. We found no significant impact of concomitant clobazam use on the efficacy and safety of CBD. In the safety analysis, 28.2% (n = 22) of patients presented adverse events related to CBD and drug-retention rate was 78.2%. CONCLUSIONS: In a real-world setting, highly purified CBD has been shown to be safe and effective for the treatment of drug resistant epilepsy not related to Lennox-Gastaut syndrome, Dravet syndrome or Tuberous Sclerosis Complex. Based on these findings, highly purified CBD should be considered as an adjuvant therapy for drug resistant epilepsy, regardless of its underlying cause or specific syndrome. Nevertheless, this assumption should be validated through further controlled trials.


Asunto(s)
Cannabidiol , Epilepsia Refractaria , Epilepsias Mioclónicas , Síndrome de Lennox-Gastaut , Esclerosis Tuberosa , Humanos , Adulto Joven , Adulto , Síndrome de Lennox-Gastaut/tratamiento farmacológico , Epilepsia Refractaria/tratamiento farmacológico , Anticonvulsivantes/efectos adversos , Esclerosis Tuberosa/complicaciones , Esclerosis Tuberosa/tratamiento farmacológico , Estudios Retrospectivos , Epilepsias Mioclónicas/tratamiento farmacológico , Convulsiones/tratamiento farmacológico
2.
Antibiotics (Basel) ; 10(5)2021 Apr 21.
Artículo en Inglés | MEDLINE | ID: mdl-33919103

RESUMEN

This retrospective, multicenter observational study aimed to describe the outcomes of surgical and medical treatment of C. acnes-related prosthetic joint infection (PJI) and the potential benefit of rifampin-based therapies. Patients with C. acnes-related PJI who were diagnosed and treated between January 2003 and December 2016 were included. We analyzed 44 patients with C. acnes-related PJI (median age, 67.5 years (IQR, 57.3-75.8)); 75% were men. The majority (61.4%) had late chronic infection according to the Tsukayama classification. All patients received surgical treatment, and most antibiotic regimens (43.2%) included ß-lactam. Thirty-four patients (87.17%) were cured; five showed relapse. The final outcome (cure vs. relapse) showed a nonsignificant trend toward higher failure frequency among patients with previous prosthesis (OR: 6.89; 95% CI: 0.80-58.90) or prior surgery and infection (OR: 10.67; 95% IC: 1.08-105.28) in the same joint. Patients treated with clindamycin alone had a higher recurrence rate (40.0% vs. 8.8%). Rifampin treatment did not decrease recurrence in patients treated with ß-lactams. Prior prosthesis, surgery, or infection in the same joint might be related to recurrence, and rifampin-based combinations do not seem to improve prognosis. Debridement and implant retention appear a safe option for surgical treatment of early PJI.

3.
Rev. colomb. quím. (Bogotá) ; 49(1): 20-25, Jan.-Apr. 2020. tab, graf
Artículo en Inglés | LILACS-Express | LILACS | ID: biblio-1098955

RESUMEN

Abstract Some bacteria release volatile organic compounds (VOCs) that can influence the growth of other microorganisms including some pathogens. Identifying bacteria with antifungal activity makes it possible to use such bacteria in the development of biocontrol agents. Thus, the present study focuses on screening VOCs released by eight isolates from Paenibacillus genus, collected at Old Providence and Santa Catalina coral reef (Colombian Caribbean Sea), with antifungal activity against phytopathogenic fungi Colletotrichum gloeosporioides 26B. The VOCs from Paenibacillus sp (PNM-50) showed inhibition rates higher than 50% in the mycelial fungi growth accompanied by macroscopic morphological changes and a reduction in conidiation. In order to identify the VOCs responsible for this antifungal bioactivity, Headspace-Solid Phase Microextraction (HS-SPME) from the bacterial culture was conducted, followed by Gas Chromatography Mass Spectrometry (GC-MS). The chromatographic results revealed a high abundance of VOCs released just by culture media. Once, the difference between VOCs emitted by culture media and bacteria was established, it was possible to make a putative identification of 2-furanmethanol, phenylacetonitrile, and 2,4-dimethylpentanol as possible VOCs responsible for the antifungal activity.


Resumen Algunas bacterias liberan compuestos orgánicos volátiles (COVs) que pueden influir en el crecimiento de otros microorganismos incluyendo algunos patógenos. La identificación de bacterias con actividad antifúngica hace posible el uso de tales bacterias en el desarrollo de agentes de biocontrol. Así pues, en este estudio, se realizó un examen dirigido exclusivamente a los COVs emitidos por ocho aislamientos bacterianos del género Paenibacillus, recolectados en el arrecife de coral de Providencia y Santa Catalina (Mar Caribe colombiano), con actividad antifúngica contra el hongo fitopatógeno Colletotrichum gloeosporioides 26B. Los COVs del aislamiento Paenibacillus sp (PNM-50) mostraron tasas de inhibición superiores al 50% en el crecimiento micelial del hongo, acompañado de cambios morfológicos macroscópicos y una reducción en la conidiación. Para identificar los COVs responsables de esta bioactividad antifúngica, se realizó microextracción en fase sólida del espacio de cabeza (HS-SPME) del cultivo de las bacterias y posterior análisis por cromatografía de gases acoplada a espectrometría de masas (GC-MS). Los resultados cromatográficos revelaron gran abundancia de COVs emitidos por los medios de cultivo. Una vez que se estableció la diferencia entre los COVs emitidos por el medio de cultivo y las bacterias, fue posible identificar tentativamente 2-furanmetanol, fenilacetonitrilo y 2,4-dimetilpentanol como COVs posiblemente responsables de la actividad antifúngica.


Resumo Algumas bactérias liberam compostos orgânicos voláteis (COV) que podem influenciar o crescimento de outros microorganismos, incluindo alguns patógenos. A identificação de bactérias com atividade antifúngica, possibilita seu uso no desenvolvimento de agentes de biocontrole. Neste estudo, foi realizada uma triagem focada nos COV liberados por oito isolados bacterianos do gênero Paenibacillus, coletados nos recifes de coral Old Providence e Santa Catalina (mar do Caribe colombiano), com atividade antifúngica contra fungos fitopatogênicos Colletotrichum gloeosporioides 26B. Os COV de Paenibacillus sp (PNM-50) apresentaram taxas de inibição superiores à 50% sobre o crescimento de fungos miceliais, acompanhadas de alterações morfológicas macroscópicas e redução da conidiação. Para identificar os COV responsáveis por essa bioatividade antifúngica, foi conduzida uma Microextração de Fase Sólida Headspace (HS-SPME) da cultura bacteriana e, em seguida, foi analisada por Cromatografia Gasosa associada à Espectrometria de Massa (GCMS). Os resultados cromatográficos revelaram uma alta abundância de COVs liberados apenas pelos meios de cultura. Uma vez estabelecida a diferença entre os COV emitidos pelos meios de cultura e bactérias, foi possível fazer uma identificação parcial de 2-furanmetanol, fenilacetonitrila e 2,4-dimetilpentanol como possíveis COV responsáveis pela atividade antifúngica.

4.
Acta neurol. colomb ; 35(2): 74-88, abr.-jun. 2019. tab, graf
Artículo en Español | LILACS | ID: biblio-1010941

RESUMEN

RESUMEN INTRODUCCIÓN: El estado epiléptico (EE) es una condición ocasionada por la falla en los mecanismos de supresión de las crisis epilépticas. Se considera como una urgencia neurológica y obliga al profesional de la salud a conocer las características de presentación para poder estabilizar al paciente. La mortalidad varía entre el 2 % y el 50 % según el grupo etario. OBJETIVO: Construir una serie de sugerencias para el tratamiento del EE, como resultado del consenso por común acuerdo de expertos en epilepsia, teniendo en cuenta el contexto colombiano. MÉTODOS: Se llevó a cabo un consenso formal de expertos con 16 neurólogos-epileptólogos de adultos y niños. Las preguntas y sugerencias fueron revisadas en dos fases, donde fueron calificadas y consensuadas por los participantes. RESULTADOS: Se evaluaron 15 preguntas, con sus respectivas sugerencias sobre el manejo del estado epiléptico, se tuvieron en cuenta referencias bibliográficas relevantes consideradas por los expertos y de acuerdo con el contexto colombiano. CONCLUSIONES: Los resultados de este consenso presentan una serie de sugerencias para el tratamiento del estado epiléptico tanto en los primeros niveles de atención como en los de alta complejidad para mejorar el pronóstico del paciente, de acuerdo con el contexto colombiano.


SUMMARY INTRODUCTION: Status epilepticus is a condition caused by failure in the mechanisms of suppression of epileptic seizures. It is considered a neurological emergency, and mortality varies between 2 % to 50 % according to the age group. Due to the above, it is relevant that health professionals know the characteristics of SE in order to stabilize the patient. OBJECTIVE: To define a series of propositions for the treatment of SE, as a result of consensus by common agreement of experts in epilepsy, taking into account the Colombian context. METHODS: A formal consensus of experts was carried out with 16 adult and pediatric neurologists-epilep-tologists. The questions and propositions were reviewed in two phases, where they were graded and agreed by the participants. RESULTS: Fifteen questions were evaluated on the management of status epilepticus. Relevant bibliographic references were considered by the experts according to the Colombian context. CONCLUSIONS: As results of this consensus we present a series of propositions for the treatment of status epilepticus for the primary level of care and high complexity level of care in order to improve the patient's prognosis, according to the Colombian context.


Asunto(s)
Movilidad en la Ciudad
5.
J Clin Med ; 8(5)2019 May 13.
Artículo en Inglés | MEDLINE | ID: mdl-31086080

RESUMEN

The aim of our study was to characterize the etiology of prosthetic joint infections (PJIs)-including multidrug-resistant organisms (MDRO)-by category of infection. A multicenter study of 2544 patients with PJIs was performed. We analyzed the causative microorganisms according to the Tsukayama's scheme (early postoperative, late chronic, and acute hematogenous infections (EPI, LCI, AHI) and "positive intraoperative cultures" (PIC)). Non-hematogenous PJIs were also evaluated according to time since surgery: <1 month, 2-3 months, 4-12 months, >12 months. AHIs were mostly caused by Staphylococcus aureus (39.2%) and streptococci (30.2%). EPIs were characterized by a preponderance of virulent microorganisms (S. aureus, Gram-negative bacilli (GNB), enterococci), MDROs (24%) and polymicrobial infections (27.4%). Conversely, coagulase-negative staphylococci (CoNS) and Cutibacterium species were predominant in LCIs (54.5% and 6.1%, respectively) and PICs (57.1% and 15.1%). The percentage of MDROs isolated in EPIs was more than three times the percentage isolated in LCIs (7.8%) and more than twice the proportion found in AHI (10.9%). There was a significant decreasing linear trend over the four time intervals post-surgery for virulent microorganisms, MDROs, and polymicrobial infections, and a rising trend for CoNS, streptococci and Cutibacterium spp. The observed differences have important implications for the empirical antimicrobial treatment of PJIs.

6.
Acta neurol. colomb ; 34(3): 175-183, sep.2018. tablas, gráficas
Artículo en Español | LILACS | ID: biblio-968819

RESUMEN

INTRODUCCIÓN: las epilepsias genéticas generalizadas (EGG) siguen patrones de herencia compleja. Este fenotipo es producto de la interacción de diferentes genes con factores ambientales. Los genes/loci más consistentemente asociados con este grupo de epilepsias son ECA1, ECA2-GABRG2, ECA3-CLCN2 (también conocido como JME6-CLCN2), JME1-EFHC1 y JME5-GABRA1. En Colombia poco se sabe sobre la contribución de las variantes genéticas en estos genes a la susceptibilidad para ser afectado por cualquiera de las formas de EGG. Nuestro propósito fue evaluar el papel de los cinco genes/loci más consistentemente asociados en otros estudios en un grupo de familias colombianas con EGG. MÉTODOS: se evaluaron dos marcadores para cada locus/gen. Los genotipos se obtuvieron mediante las técnicas de PCR-RFLP y ARMS-Tetraprimer. Los análisis estadísticos incluyeron pruebas de asociación alélica y haplotípica, además de pruebas de interacción gen-gen. RESULTADOS: se incluyeron 98 familias, de las cuales 51 fueron epilepsia de ausencias, mientras que 47 fueron epilepsia mioclónica juvenil. Se identificó una interacción significativa entre el alelo G del marcador rs4428455 (valor P=0,0008; gen GABRA1) y el alelo G de marcador rs719395 (valor P=0,002; gen EFHC1). CONCLUSIÓN: estos dos marcadores parecen incrementar el riesgo de EGG en población colombiana. Otros genes no analizados aquí podrían estudiarse con una muestra de mayor tamaño


INTRODUCTION: Generalized genetic epilepsies (GGE) follow complex inheritance patterns. This phenotype is due to interaction of several genes with environmental factors. The genes/loci most consistently associated with this group of epilepsies are ECA1, ECA2-GABRG2, ECA3-CLCN2 (also known as JME6-CLCN2), JME1-EFHC1 and JME5-GABRA1. In Colombia, little is known about the contribution of gene variants to susceptibility to GGE forms. Our purpose was to evaluate the role of the five most consistently associated genes /loci in other studies, in Colombian families set with GGE. METHODS: Genotypes were obtained by means of PCR-RFLP and ARMS-Tetraprimer. Statistical analyses included both allelic and haplotypic association tests, in addition to gene-gene interaction tests. Two genetic markers were tested for each gene/locus. RESULTS: Ninety-eight families were included, from which 51 had absence epilepsy, and 47 had juvenile myoclonic epilepsy. A significant interaction was identified between allele G at marker rs4428455 (P-value= 0.0008; gene GABRA1) and allele G at marker rs719395 (P-value= 0.002; gene EFHC1). CONCLUSION: Our results suggest that these two markers are associated with GGE in the Colombian population. Other genes not analyzed could be tested using a larger sample size.


Asunto(s)
Humanos , Epilepsia Generalizada , Epilepsia , Genes
7.
Rev Esp Quimioter ; 28(5): 256-62, 2015 Oct.
Artículo en Español | MEDLINE | ID: mdl-26437756

RESUMEN

INTRODUCTION: Bloodstream infections due to multire-sistant Enterobacteriaceae are a major matter of concern nowadays. The present study evaluated the impact of these infections in our area. METHODS: Prospective observational study of a cohort of patients with bacteraemia due to extended-spectrum beta-lactamases (ESBL) and other beta-lactamases producing organisms among hospitalized patients in Cruces Hospital for 2 years. We conducted a descriptive analysis, a subgroup analysis (cancer vs. non-cancer patients) and a mortality analysis. RESULTS: During the study period, 3409 episodes of bacteraemia were diagnosed, of which 124 (3.6%) were ESBL and other beta-lactamases producing Enterobacteriaceae. 40.3% of the cases were nosocomial, 15.3% community acquired and 44.4% were health-care associated. 44.4% of the cohort had cancer as underlying disease. The most commonly isolated organism was E. coli (83% of cases), regardless of the source of infection. 58.1% of patients received inadequate empirical therapy. 7 day-mortality was 10.5% and 30 day-mortality was 21.8%. None of the analyzed variables showed association with 7 and 14 day-mortality, but the presence of solid cancer (p= 0.032) and advanced HIV infection (p = 0.027), were significantly associated with higher 30 day-mortality. CONCLUSIONS: More than half of bacteraemia episodes affected outpatients and most of them were health-care associated episodes. Even though more than half of the patients received inadequate empirical treatment, this was not related to higher mortality. We only found an association between 30 day-mortality and the presence of underlying solid malignancy or advanced HIV infection.


Asunto(s)
Bacteriemia/microbiología , Proteínas Bacterianas/metabolismo , Infección Hospitalaria/microbiología , Infecciones por Enterobacteriaceae/microbiología , Neoplasias/complicaciones , beta-Lactamasas/metabolismo , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Bacteriemia/etiología , Bacteriemia/mortalidad , Estudios de Cohortes , Enterobacteriaceae/efectos de los fármacos , Infecciones por Enterobacteriaceae/etiología , Infecciones por Enterobacteriaceae/mortalidad , Infecciones por Escherichia coli/microbiología , Femenino , Mortalidad Hospitalaria , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Estudios Prospectivos
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