RESUMEN
OBJECTIVES: Tropheryma whipplei has been detected in 3.5% of the blood culture-negative cases of endocarditis in Spain. Experience in the management of T. whipplei endocarditis is limited. Here we report the long-term outcome of the treatment of previously reported patients who were diagnosed with infective endocarditis (IE) caused by T. whipplei from the Spanish Collaboration on Endocarditis-Grupo de Apoyo al Manejo de la Endocarditis Infecciosa en España (GAMES) and discuss potential options for antimicrobial therapy for IE caused by T. whipplei. PATIENTS AND METHODS: Seventeen patients with T. whipplei endocarditis were recruited between 2008 and 2014 in 25 Spanish hospitals. Patients were classified according to the therapeutic regimen: ceftriaxone and trimethoprim/sulfamethoxazole, doxycycline + hydroxychloroquine and other treatment options. RESULTS: Follow-up data were obtained from 14 patients. The median follow-up was 46.5 months. All patients completed the antibiotic treatment prescribed, with a median duration of 13 months. Six patients were treated with ceftriaxone and trimethoprim/sulfamethoxazole (median duration 13 months), four with doxycycline + hydroxychloroquine (median duration 13.8 months) and four with other treatment options (median duration 22.3 months). The follow-up after the end of the treatments was between 5 and 84 months (median 24 months). CONCLUSIONS: All treatment lines were effective and well tolerated. Therapeutic failures were not detected during the treatment. None of the patients died or experienced a relapse during the follow-up. Only six patients received antibiotic treatment in accordance with guidelines. These data suggest that shorter antimicrobial treatments could be effective.
Asunto(s)
Antibacterianos/uso terapéutico , Endocarditis Bacteriana/tratamiento farmacológico , Endocarditis Bacteriana/microbiología , Tropheryma/efectos de los fármacos , Tropheryma/fisiología , Anciano , Antibacterianos/farmacología , Quimioterapia Combinada , Endocarditis Bacteriana/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , España , Resultado del TratamientoRESUMEN
Fowl typhoid (FT) caused by Salmonella Gallinarum (SG) is a poultry disease distributed worldwide that has been eradicated in commercial production of many developed countries but still persists in many developing countries. Vaccination is one of the main strategies to reduce mortality, clinical signs, and vertical or horizontal transmission. The aim of this work was to assess the protection against FT conferred by vaccines based on Salmonella Enteritidis (SE), SG, or a combination. Five experimental groups of birds, vaccinated with different live or inactivated SG and SE vaccines were included in the trial: 1) two doses of a SG-SE bivalent inactivated vaccine; 2) four doses of the live attenuated SE vaccine; 3) three doses of the live attenuated SE vaccine and two doses of the SG-SE bivalent inactivated vaccine; 4) two doses of the live attenuated SG9R vaccine; and 5) unvaccinated birds. At 28 wk of age, all hens were challenged with a virulent strain of SG, and mortality was recorded during the subsequent 15 days. The results showed that the plan that included only the inactivated vaccine did not show significant protection (P = 1), while the plan based on the administration of the attenuated strain of SE significantly reduced mortality in the group of birds (P = 0.0309). However, the highest levels of protection were obtained in the group of hens immunized with the combination of the inactivated vaccine and the live attenuated SE strain (P < 0.0001), which was statistically similar to the homologous protection conferred by the SG 9R strain, a vaccine used in many countries to control FT. These results demonstrate that the combination of existing vaccines together with strict biosecurity measures on farms may help improve the control of the pathogen in countries where FT in an emerging or reemerging disease.
Nota de investigación- Combinación de vacunas vivas e inactivadas contra Salmonella para proteger contra la tifoidea aviar en gallinas de postura. La tifoidea aviar (FT) causada por Salmonella enterica serotipo Gallinarum biovar Gallinarum (SG) es una enfermedad distribuida en todo el mundo que ha sido erradicada de la producción av'icola comercial de muchos pa'ises desarrollados pero que aún persiste en muchos pa'ises en desarrollo. La vacunación es una de las principales estrategias para reducir la mortalidad, los signos cl'inicos y la transmisión vertical u horizontal. El objetivo de este trabajo fue evaluar la protección contra la tifoidea aviar conferida por vacunas elaboradas con Salmonella enterica serotipo Enteritidis (SE), SG o una combinación de ellas. Se incluyeron en el ensayo cinco grupos experimentales de aves, vacunadas con diferentes vacunas de SG y SE vivas o inactivadas: 1) dos dosis de una vacuna bivalente inactivada de SG y SE; 2) cuatro dosis de la vacuna SE viva atenuada; 3) tres dosis de vacuna SE viva atenuada y dos dosis de vacuna bivalente inactivada SG y SE; 4) dos dosis de la vacuna SG 9R viva atenuada; y 5) aves no vacunadas. A las 28 semanas de edad, todas las gallinas fueron expuestas a una cepa virulenta de SG y se registró la mortalidad durante los 15 d'ias siguientes. Los resultados mostraron que el plan que inclu'ia solo la vacuna inactivada no mostró protección significativa (P=1), mientras que el plan basado en la administración de la cepa atenuada de S. Enteritidis redujo significativamente la mortalidad en el grupo de aves (P = 0,0309). Sin embargo, los mayores niveles de protección se obtuvieron en el grupo de gallinas inmunizadas con la combinación de la vacuna inactivada y la cepa viva atenuada de SE (P < 0,0001), la cual fue estad'isticamente similar a la protección homóloga conferida por la cepa de SG 9R, que es una vacuna utilizada en muchos pa'ises para controlar la tifoidea aviar. Estos resultados demuestran que la combinación de las vacunas existentes junto con estrictas medidas de bioseguridad en las granjas puede ayudar a mejorar el control del patógeno en pa'ises donde la tifoidea aviar es una enfermedad emergente o reemergente.
Asunto(s)
Pollos , Enfermedades de las Aves de Corral , Salmonelosis Animal , Vacunas contra la Salmonella , Vacunas Atenuadas , Vacunas de Productos Inactivados , Animales , Enfermedades de las Aves de Corral/prevención & control , Enfermedades de las Aves de Corral/microbiología , Salmonelosis Animal/prevención & control , Vacunas de Productos Inactivados/administración & dosificación , Vacunas de Productos Inactivados/inmunología , Vacunas contra la Salmonella/inmunología , Vacunas contra la Salmonella/administración & dosificación , Vacunas Atenuadas/administración & dosificación , Vacunas Atenuadas/inmunología , Femenino , Salmonella enteritidis/inmunologíaRESUMEN
We report the case of a 68-year-old male with a diagnosis of unclassifiable myelodysplatic/myeloproliferative disease (WHO classification), under prolonged steroid treatment and unsuccesful chemotherapy response, who developed progressive asthenia, thoracic pain, minimal efforts dyspnea, and abdominal distension, that initially was suspicious of splenic rupture. Exploratory laparotomy showed multiple peritoneal implants, and a diagnosis of peritoneal tuberculosis was obtained from local biopsy. Definitive diagnosis included a positive result to culture and PCR urine test, together with a possible pleural and splenic tuberculous affectation. Response to tuberculostatic treatment was successful. To the best of our knowledge, this is the first reported case with such characteristics.
Asunto(s)
Enfermedades Mielodisplásicas-Mieloproliferativas/complicaciones , Peritonitis Tuberculosa/etiología , Anciano , Antituberculosos/uso terapéutico , Biopsia , Humanos , Masculino , Enfermedades Mielodisplásicas-Mieloproliferativas/clasificación , Peritoneo/patología , Peritonitis Tuberculosa/diagnóstico , Peritonitis Tuberculosa/tratamiento farmacológico , Peritonitis Tuberculosa/patología , Resultado del Tratamiento , Organización Mundial de la SaludRESUMEN
INTRODUCTION: some clinical, anatomo-pathological, and technical factors influence the correct healing of intestinal suture following an intestinal resection. One of the most influential factors is patient nutritional status. OBJECTIVES: to evaluate the influence of malnutrition on the viability of primary intestinal anastomosis by the analysis of collagen I deposition. METHODS: 40 Wistar rats, radioimmunoassay material. We used 2 groups of rats, 20 animals in each group: a control group (A) and a "malnutrition" group (B). RESULTS: there was a decrease in PINP (procollagen) deposition in the colon of group B rats as compared to the colon of group A (0.3620 and 0.4340 mg/g respectively) (p = 0.032). There is an increase in ICTP (carboxyterminal telopeptide) in the colon of group B (0.9545 as against 0.8460 mg/g in group A) (p = 0.875). In anastomoses of group B there was a decrease in PINP synthesis as compared to group A (0.376 and 0.468 mg/g respectively, p = 0.002). As regards ICTP, there was an increase in group B (p = 0.330). In relation to the control group no differences were observed in ICTP increases in group B (p = 1). CONCLUSIONS: colonic anastomosis increases the levels of PINP and ICTP in healed tissue (p = 0.000); malnutrition reduces collagenization in anastomoses (p = 0.000).
Asunto(s)
Anastomosis Quirúrgica , Colon/cirugía , Desnutrición/complicaciones , Fragmentos de Péptidos/análisis , Procolágeno/análisis , Animales , Colágeno Tipo I , Modelos Animales de Enfermedad , Femenino , Estado Nutricional , Péptidos , Radioinmunoensayo , Ratas , Ratas Wistar , Cicatrización de HeridasRESUMEN
INTRODUCTION: The use of the Internet to gain health information has increased in Spain. This is changing the way patients access medical information and, in turn, the physician-patient relationship. OBJECTIVES: To analyze the use of the Internet for medical purposes by patients attending a digestive diseases office and to determine the profile of patients seeking this information. MATERIAL AND METHODS: A questionnaire was administered to consecutive patients attending a general digestive diseases office for the first time. RESULTS: Four hundred twenty-three patients completed the questionnaire (56% women, 44% men, mean age 42.63 [15.994] years). A total of 2.4% had only not completed basic education, 14% had completed basic education, 32.8% had completed high school, 50.6% had university degrees, and 0.2% did not answer. More than three-quarters (76.4%) had a computer at home and 72% had internet access. Forty-two percent looked for health information on the internet. Seventeen percent had searched for specific information on their illnesses before consulting and 66% believed the internet is a good resource for obtaining medical information. Seventy percent would be interested in a specific web page on digestive disease topics and 75% would use e-mail to consult with their physicians. The group that most frequently looked for medical information consisted of patients aged 45 years or younger with secondary school or university education. CONCLUSIONS: In our environment, patients with digestive diseases routinely use the Internet to search for medical information. These patients have a high degree of confidence in the information obtained and would be interested in a specific website devoted to diseases of the digestive system. The patients that most frequently searched for health information were aged less than 45 years old and had secondary school education or university degrees.
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Enfermedades del Sistema Digestivo/psicología , Gastroenterología , Internet/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Pacientes/psicología , Adulto , Islas del Atlántico , Recolección de Datos , Escolaridad , Femenino , Humanos , Difusión de la Información , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Encuestas y CuestionariosRESUMEN
Diarrhoeic diseases caused by water and food contaminated by enteropathogens continue to be an important cause of morbidity in countries with a low level of development. Some 50,000 cases of diarrhoea in travellers are estimated in the world every day, and this is the main cause of consultation by travellers who return from undeveloped zones. The principal determinant of risk is the place of destination; there are significant differences between different regions with respect to risk and to the aetiology of the diarrhoea. The most frequent cause of diarrhoeas is of bacterial origin, which represents between 60 and 85% of the cases, while parasites represent 10% and some 5% are produced by viruses. Although it normally follows a benign course, complications can arise, with mortality being only exceptionally associated to this disease. Prevention is essentially based on strictly following elemental hygienic measures and avoiding the ingestion of foodstuffs and drinks with a risk of contamination. Prophylaxis with antibiotics is only advisable in journeys of short duration, in which the risk and/or seriousness of diarrhoeas, above all in immunosuppressed patients, are higher than the possible collateral effects. The treatment of diarrhoea in the traveller is based on adequate hydration, and the use of microbians is reserved for moderate and serious situations, with quinolones being the drug of choice. Rifaximine is a new drug approved for the treatment of diarrhoeas in the traveller, above all in areas with enteropathogens that are resistant to quinolones.
Asunto(s)
Diarrea , Viaje , Diarrea/diagnóstico , Diarrea/epidemiología , Diarrea/etiología , Diarrea/terapia , Humanos , Factores de RiesgoRESUMEN
The most frequent etiology of visceral artery aneurysms is arteriosclerosis, but vascular manipulation during hepatic transplantation may also cause a mycotic pseudoaneurysm. Treatment with embolization, stents or percutaneous thrombin injection have been recommended but surgical revascularization is indicated when interventional techniques fail. A 43-year-old man with hepatitis C virus cirrhosis who underwent orthotopic liver transplantation from a cadaveric donor was treated with cyclosporine, mycophenolate, and steroids and was discharged from hospital at 35 days. Two months later he was readmitted with a febrile syndrome. Abdominal computed tomography showed necrosis of hepatic segments IV, V, and VI. Magnetic resonance imaging and angiography revealed partial thrombosis of the hepatic artery and stenosis of the portal anastomosis secondary to an aneurysm of the hepatic artery. A few hours after the radiological diagnosis, the patient suffered a bout of upper gastrointestinal bleeding and shock. Emergency surgery revealed a mycotic pseudoaneurysm of the common hepatic artery, which had ruptured into the bile tract with hemobilia. The liver graft was removed because of severe necrosis of the right liver. The patient died awaiting a new liver transplantation.
Asunto(s)
Aneurisma Falso/diagnóstico , Arteria Hepática , Trasplante de Hígado/efectos adversos , Vena Porta , Adulto , Anastomosis Quirúrgica , Aneurisma Falso/microbiología , Aneurisma Falso/cirugía , Cadáver , Humanos , Inmunosupresores/efectos adversos , Imagen por Resonancia Magnética , Masculino , Micosis/complicaciones , Donantes de TejidosRESUMEN
Peripheral and autonomic neuropathy has been evaluated, both by clinical and neurophysiological and by clinical methods, respectively, in 33 alcoholics, 20 of them cirrhotics. Nerve dysfunction was compared with liver function parameters, the Child-Pugh score, and parameters derived from ethanol consumption. Few relationships were obtained between the autonomic and peripheral nerve dysfunction, and between these and liver function impairment, although Pugh's score was higher when hyporeflexia and altered heart rate response to orthostatism were present. Thus, in the alcoholic, autonomic and peripheral neuropathy, seem to be dependent on each other, whereas there appears to be a weak correlation between liver function and both autonomic and peripheral neuropathy.
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Enfermedades del Sistema Nervioso Autónomo/etiología , Cirrosis Hepática Alcohólica/complicaciones , Enfermedades del Sistema Nervioso Periférico/etiología , Adulto , Enfermedades del Sistema Nervioso Autónomo/diagnóstico , Femenino , Encefalopatía Hepática/complicaciones , Encefalopatía Hepática/diagnóstico , Humanos , Cirrosis Hepática Alcohólica/diagnóstico , Pruebas de Función Hepática , Masculino , Persona de Mediana Edad , Examen Neurológico , Enfermedades del Sistema Nervioso Periférico/diagnósticoRESUMEN
BACKGROUND: The natural history of HIV infection and its related diseases has changed after the introduction of new potent antiretroviral therapies (HAART). We have performed this study to analyse in our hospital the natural history of HIV infection in relation to the therapeutics advances. PATIENTS AND METHODS: We have exhaustively revised the clinic records of all the 807 adult HIV-infected patients followed at the HUC from January 1985 to December 1999. RESULTS: The incidence of most opportunistic diseases, new AIDS cases, hospital admissions and deaths decreased as from 1997. Patients who started antiretroviral therapy with HAART had lower incidence of AIDS, hospital admissions and deaths than patients with other therapy modalities. Survival of patients placed on HAART was better than that of patients who received different therapy modalities (p < 0.001), independently on the intensity of immunosuppression and AIDS diagnosis. Multivariate analysis showed that HAART therapy was the best protector factor, decreasing the risk of progression to death (p < 0.001). CONCLUSIONS: HAART therapy leads an important improvement of survival of HIV infected patients, independently an the intensity of immunosuppression and slows HIV progression, decreasing the number of new AIDS cases, hospital admissions and deaths.
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Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , VIH-1 , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Infecciones Oportunistas Relacionadas con el SIDA/mortalidad , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Adulto , Terapia Antirretroviral Altamente Activa/métodos , Femenino , Infecciones por VIH/mortalidad , Humanos , Incidencia , Masculino , Análisis Multivariante , España/epidemiología , Factores de TiempoRESUMEN
Primary effusion lymphoma (PEL) is a recently individualized form of non-Hodgkin lymphoma (WHO classification) that mainly develops in HIV infected males, more frequently in homosexuals and advanced stages of the disease (total CD4+ lymphocyte count below 100-200/mL). Occasionally, it appears in others immunodepressive states (such as solid organs postransplant period) and even, although very rarelly, in immunocompetents patients. From a pathogenetic point of view, PEL has been related to Kaposi's sarcoma-associated herpes virus (also named human herpesvirus 8) and to the clinical antecedent of Kaposís sarcoma. Relative unfrequency of this disease, the absence of wide casuistics allowing a better characterization, and its unfavorable outcome, support the need of a deeper knowledge. We present here the clinical-biological findings of three patients that were diagnosed of pleural PEL in our institution in the last two years.
Asunto(s)
Infecciones por VIH/complicaciones , VIH-1/aislamiento & purificación , Herpesvirus Humano 8/aislamiento & purificación , Linfoma no Hodgkin/complicaciones , Cavidad Pleural/patología , Adulto , Biopsia , Recuento de Linfocito CD4 , Infecciones por VIH/patología , Infecciones por VIH/virología , Humanos , Linfoma no Hodgkin/patología , Linfoma no Hodgkin/virología , Masculino , Pleura/patología , Pleura/virología , Cavidad Pleural/virologíaAsunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Criptococosis/tratamiento farmacológico , Cryptococcus neoformans , Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Adulto , Antifúngicos/uso terapéutico , Líquido del Lavado Bronquioalveolar/microbiología , Criptococosis/microbiología , Quimioterapia Combinada , Humanos , MasculinoRESUMEN
PURPOSE: Our objective was to analyze the advantages and inconveniences associated with the use of fibrin sealant compared with mechanical means for mesh fixation following abdominal-wall surgery. METHODS: Literature search was conducted in MedLine, EMBASE, and Cochrane Library Plus databases. Articles were randomized clinical trials, nonrandomized comparative studies, and case series containing at least ten patients. RESULTS: The fibrin sealant was shown to be biocompatible with the surrounding tissue. In patients treated with fibrin sealant, lower prevalence of acute and chronic postoperative pain was observed, and less hemorrhagic complications occurred. There are no data on the influence of fibrin sealant on seroma decrease. Efficiency in experimental models was similar to that observed for mechanical methods of fixation. Also, adhesions with fibrin sealant were less than that for mechanical methods. CONCLUSIONS: Compared with mechanical methods, fibrin sealant is an efficacious alternative for mesh fixation postsurgery of the abdominal wall.
Asunto(s)
Pared Abdominal/cirugía , Adhesivo de Tejido de Fibrina/uso terapéutico , Hernia Abdominal/cirugía , Adhesivos Tisulares/uso terapéutico , Animales , Adhesivo de Tejido de Fibrina/efectos adversos , Humanos , Dolor Postoperatorio/etiología , Mallas Quirúrgicas , Suturas/efectos adversos , Adhesivos Tisulares/efectos adversosRESUMEN
Athletes and other physically active people often suffer prolonged inguinal pain, which can become a serious debilitating condition and may place an athlete's career at risk. A sportsmen hernia is a controversial cause of this chronic groin pain, as it is difficult to be defined. From an anatomical point of view, the definition and the name of this entity should be reviewed. In the majority of athletic manoeuvres, a tremendous amount of torque or twisting occurs in the mid-portion of the body and the front, or anterior portion, of the pelvis accounts for the majority of the force. The main muscles inserting at or near the pubis are the rectus abdominis muscle, which combines with the transversus abdominis. Across from these muscles, and directly opposing their forces, is the abductor longus. These opposing forces cause a disruption of the muscle/tendon at their insertion site on the pubis, so the problem could be related to the fact that the forces are excessive and imbalanced, and a weak area at the groin could be increased due to the forces produced by the muscles. The forces produced by these muscles may be imbalanced and could produce a disruption of the muscle/tendon at their insertion site on the pubis or/and a weak area may be increased due to the forces produced by the muscles, and just this last possibility could be defined as "sportsmen hernia." In conclusion, this global entity could be considered to be an imbalance of the muscles (abductor and abdominal) at the pubis, that leads to an increase of the weakness of the posterior wall of the groin and produces a tendon enthesitis, once a true origin is not detected, that may lead to a degenerative arthropathy of the pubic symphysis in the advanced stages. Based on this, this entity could be re-named as "syndrome of muscle imbalance of the groin" and the sportsmen hernia could be considered as an entity included in this syndrome. It is recommended that a multidisciplinary approach is given to this entity, since the present literature does not supply the proper diagnostic studies and the correct treatment which should be performed in these patients.