Bivalirudin versus heparin in patients undergoing percutaneous peripheral interventions: A systematic review and meta-analysis.

BACKGROUND: Bivalirudin may be an effective alternative anticoagulant to heparin for use in percutaneous peripheral interventions. We aimed to compare the safety and efficacy of bivalirudin versus heparin as the procedural anticoagulant agent in patients undergoing percutaneous peripheral intervention. METHODS: For this meta-analysis and systematic review, we conducted a search in PubMed, Medline, Embase, and Cochrane for all the clinical studies in which bivalirudin was compared to heparin as the procedural anticoagulant in percutaneous peripheral interventions. Outcomes studied included all-cause mortality, all-bleeding, major and minor bleeding, and access site complications. RESULTS: Eleven studies were included in the analysis, totaling 20,137 patients. There was a significant difference favoring bivalirudin over heparin for all-cause mortality (risk ratio 0.58, 95% CI 0.39-0.87), all-bleeding (risk ratio 0.62, 95% CI 0.50-0.78), major bleeding (risk ratio 0.61, 95% CI 0.39-0.96), minor bleeding (risk ratio 0.66, 95% CI 0.47-0.92), and access site complications (risk ratio 0.66, 95% CI 0.51-0.84). There was no significant difference in peri-procedural need for blood transfusions (risk ratio 0.79, 95% CI 0.57-1.08), myocardial infarction (risk ratio 0.87, 95% CI 0.59-1.28), stroke (risk ratio 0.77, 95% CI 0.59-1.01), intracranial bleeding (risk ratio 0.77, 95% CI 0.29-2.02), or amputations (OR 0.75, 95% CI 0.53-1.05). CONCLUSION: Our meta-analysis suggests that bivalirudin use for percutaneous peripheral interventions is associated with lower all-cause mortality, bleeding, and access site complications as compared to heparin. Further large randomized trials are needed to confirm the current results.

[Chronic fatigue syndrome associated with Epstein-Barr virus infection]. / Síndrome de fatiga crónica asociado a infección por el virus de Epstein-Barr.

Epstein-Barr virus (EBV) infection is ubiquitous and may result in multiple and widely different clinical features; the most common of these is infectious mononucleosis (IM). Recently, a group of patients has been included in the chronic EBV infection syndrome (EBVIS), with a sustained nonspecific syndrome consisting of asthenia, anorexia, low grade fever and changes in mood, associated with a viral infection not necessarily caused by EBV; this has been called chronic fatigue syndrome (CFS). We report a patient who fulfilled the criteria for CFS associated with EBV after an acute, well documented EBV infection. We discuss its etiological and pathophysiological implications, emphasizing the need for extreme caution in the diagnosis of CFS. A merely clinical diagnosis may hide severe mistakes.

[Campylobacter pylori's sensitivity to the bactericidal action of human serum]. / Sensibilidad de Campylobacter pylori al poder bactericida del suero humano.

The sensitivity to the bactericidal power of the human serum was evaluated on 8 strains of C. pylori, 8 strains of C. jejuni, 2 strains of C. coli and 2 strains of C. fetus. Each of them was incubated at 37 degrees C in the presence of a complete pool of human sera, the same pool after inactivation of the complement, and trypticase soy broth (control). After 0, 15, 30 and 60 minutes the capacity to grow in blood agar plates (count of colonies) incubated in microaerophillic conditions for 3 days was evaluated. In this experimental study it was shown that C. pylori has a rapid and complete sensitivity to the human serum and, particularly, to the complement; this could be one of the factors that determine its lack of invasive capacity.

[Biochemical, physiological, and enzymatic study of 78 strains of Helicobacter (Campylobacter) pylori isolated from gastroduodenal biopsies]. / Estudio bioquímico, fisiológico y enzimático de 78 cepas de Helicobacter (Campylobacter) pylori aisladas en biopsias gastroduodenales.

A biochemical, physiological and enzymatic study of 78 C. pylori strains isolated from gastroduodenal biopsies is reported. All strains were positive in the oxidase, catalase and urease tests. 97.4% produced SH2 in the lead acetate band and 79.4% showed beta-hemolytic activity in sheep blood agar. In the antibiotic selection tests, C. pylori was characterized to be resistant to nalidixic acid and sensitive to cefalotin . The enzymatic study demonstrated the presence of acid and alkaline phosphatases. This finding and the urease test give C. pylori a define bacteriological character which differentiate it from the remaining campylobacteria.

[Analysis of the prevalence of anti-Campylobacter pylori antibodies detected in a healthy human population]. / Análisis de la prevalencia de anticuerpos anti-Campylobacter pylori detectados en la población humana sana.

A study was made of the prevalence of anti C. pylori in the healthy adult population. The analytical method used was indirect immunofluorescence. An analysis was made of 231 sera (122 males and 109 females) from subjects 20 to 82 years-old. The global positivity detected was 21.1%. There was a slight rise in the percentage of positivities as age increased, reaching the maximum rate in the group over 50 years (2.1%). The titers detected were low and unrelated to age. No significant differences by sex were found in the subjects analyzed.

Efficacy of the enteric pathogen screen card in the presumptive identification of Salmonella enteritidis.

The efficacy of the Enteric Pathogen Screen (EPS) card as a rapid method for identification of Salmonella spp. isolated in stool cultures was studied. Of the 120 lactose-negative, sucrose-negative, H2S-producing colonies tested, 74 were identified as Salmonella enteritidis by conventional methods. The reading of the EPS card after 2 h of incubation yielded a sensitivity of 47.2% and a specificity and positive predictive value of 100%, with a negative predictive value of 54.1%. In the final reading of 4 h, a sensitivity of 97.2% and a specificity of 86.9% were obtained, with a positive predictive value of 92.3% and a negative predictive value of 95.2%.

[Effectiveness of ClNa-esculin broth for the rapid identification of the Enterococcus genus]. / Eficacia del caldo ClNa-esculina en la identificación rápida del género Enterococcus.

The efficacy of the ClNa-esculine broth for the rapid identification (2 hours) of the species of the genus Enterococcus was evaluated and compared with the conventional biochemical methods requiring an incubation of 18-24 hours. Out of the 274 evaluated strains, 171 were positive for this investigation; 160 of them corresponded to Enterococcus spp (100%). The sensitivity of the test was 100%, the specificity 99.1%, the positive predictive value 99.3% and the negative predictive value 100%.

Urinary tract infection caused by Enterobacter taylorae.

We present a case of urinary tract infection caused by Enterobacter taylorae in a 70-year-old male with renal lithiasis. The microorganism was isolated in significant numbers from a urine culture. The disappearance of clinical symptoms after antibiotic treatment points to the participation of this microorganism as the etiological agent in the infection.

[Phenotypic characteristics of 100 strains belonging to the mesophilic aeromonas group isolated from feces]. / Estudio de las características fenotípicas de 100 cepas pertenecientes al grupo de aeromonas mesófilas aisladas en heces.

Phenotypic characteristics of 100 strains pertaining to the group of mesophilic aeromonas isolated in feces of patients with diarrhea (23 A. hydrophila, 34 A. sobria, 19 A. caviae, and 24 considered atypical because produced a the negative esculin reaction and a positive gas formation from glucose [TSI]). The percentages obtained in the different biochemical tests support the hypothesis that in this group there is a taxonomic complexity. We observed variations in the following tests: LDC, arabinose, Voges-Proskauser, lactose, and motility and hemolytic activity. We compared manual and automatic procedures in detecting esculinase and beta-galactosidase activity (ONPG). The study of constitutional enzymatic activity by means of API ZYM system can not be used to differentiate the distinct species although the enzyme beta-glucosidase is detected preferentially in A. hydrophila.

[Human infections caused by Enterobacter sakazakii. Microbiologic considerations]. / Infecciones humanas por Enterobacter sakazakii. Consideraciones microbiológicas.

The clinical and microbiological features of four patients with positive cultures for Enterobacter sakazaii are reported. They corresponded to two wound exudates, one appendicitis and one newborn conjunctivitis. The biochemical and physiological characteristics of this organism are analyzed (inability to ferment d-sorbitol and production of a non-diffusible yellow pigment); its difficult identification and the clinical rarity of its isolation are discussed. The relevant literature is reviewed.

Non-typhi Salmonella bacteraemia.

We reviewed retrospectively the clinical records of patients with non-typhi Salmonella bacteraemia in our hospital from 1979 to 1988. During the study period 45 non-typhi Salmonella bacteraemias were diagnosed in 43 patients. Ten patients were under one year old and 11 were over 60. Seven cases of sepsis presented in patients with AIDS. Only three episodes were nosocomially acquired. In two of three patients the bacteraemia was preceded by an episode of acute gastroenteritis and one third presented without gastroenteritis. Complications and mortality were infrequent in spite of the differing degrees of adequacy of antibiotic treatment which was inappropriate in many cases. We have attempted to assess optimal antibiotic therapy, taking into account the duration and means of administration, in different groups of patients with nontyphi Salmonella bacteraemia.

Microbiological characteristics of Weeksella virosa (formerly CDC group IIf) isolated from the human genitourinary tract.

Weeksella virosa (formerly CDC group IIf) is a nonsaccharolytic, oxidase- and catalase-positive, gram-negative rod which is unable to grow on MacConkey agar. At 48 h of incubation on blood or chocolate agar, the colonies present a characteristic appearance: intensely mucoid, adherent, and cream colored as a result of the production of a nondiffusible yellow pigment. This microorganism has been isolated predominantly from the female genitourinary tract, which indicates the opportunity for sexual transmission. We present the microbiological study of three strains of W. virosa identified in a study of 707 female genital samples, representing an incidence of 0.42%. At the same time, we analyzed the principal biochemical tests used in the identification of this microorganism and the susceptibilities of the organism to the different antimicrobial agents assayed.

Treatment of respiratory infections with fosfomycin.

Results are presented for a series of 29 patients, 14 males and 15 females, with serious respiratory infections, in which fosfomycin proved effective. In all cases the study was completed by bacteriological, clinical, radiological and analytical controls. The average dose was 6 g/day (3 g orally and 3 g intramuscularly) for 1 or 2 weeks. The four isolated were P. aeruginosa, E. coli, Klebsiella-Enterobacter and D. pneumoniae. Overall sensitivity percentages were best for fosfomycin, gentamicin and colistin. Of the 29 germs isolated, only one strain of P. aeruginosa became resistant: this represents 3% resistance development. No side effects of intolerance or signs of hepatorenal insufficiency were observed during the treatment. Of the 29 patients treated, 22 were clinically cured, denoting 76% success.

Analysis of the autoagglutination phenomenon, serogroup and hydrophobicity as virulence markers in mesophilic aeromonads isolated from stool cultures.

The autoagglutination phenomenon (AA) was studied in 71 strains of mesophilic aeromonads isolated from stool cultures of patients with acute diarrhea (28 Aeromonas hydrophila, 20 Aeromonas sobria, and 23 Aeromonas caviae). Two phenotypes were considered in the AA+ strains: SP+ (self-pelleting) and PAB+ (precipitation after boiling). Serogrouping of the strains was performed only with the 0:11 serum. Other properties studied were agglutination with acriflavine (Acr) and crystal violet uptake (CVB). Phenotype AA+ was found in 29.5% of the strains; 7% of these AA+ strains exhibited the SP+ PAB+ pattern and 22.5% the SP- PAB+ pattern. The species Aeromonas hydrophila comprised the highest proportion (28.5%), and Aeromonas caviae the lowest (13%). Fifty percent of the PAB+ strains of Aeromonas hydrophila and Aeromonas sobria belonged to serotype 0:11. None of the PAB+ strains of Aeromonas caviae belonged to this serotype. 8.4% of the strains were Acr+ and 23.9% CVB+.

[Analysis of the sensitivity of mesophilic Aeromonas isolated from feces to antibiotics of everyday use]. / Análisis de la sensibilidad de las Aeromonas mesófilas aisladas en heces a los antibióticos de uso cotidiano.

The sensitivity to antibiotics of 56 mesophilic strains of Aeromonas (20 A. caviae, 18 A. sobria and 18 A. hydrophila) isolated from the feces of patients with enteritis, 89.2% of strains had some type of resistance, such as 83.9% to ampicillin, 32.1% to carbenicillin, 28.8% to cefalotin, 5.3% to co-trimoxazole and 1.7% to chloramphenicol. 48.2% of strains were simultaneously resistant to two of the tested antibiotics, 3.5% to three and 5.3% to four. 95.7% of ampicillin resistant strains were beta-lactamase producing. A. sobria was more sensitive to cefalotin (MIC less than 8 micrograms/ml) than the remaining species. This finding supports the use of that marker for identification.

Intradermal and intramuscular route for vaccination against hepatitis B.

A recombinant hepatitis B vaccine was administered to high-risk hospital personnel by intramuscular (20 micrograms) or intradermal (2 micrograms) injections for the primary immunization (n = 69) with three doses and booster immunization (n = 51) with one dose. Basic vaccination performed intramuscularly gave rise to significantly higher seroconversion levels (97.2% versus 78.1%) and geometric mean titres of antibody (1649 versus 126 IUl-1) as compared with the intradermal route. Intradermal administration did not boost antibody titres in patients previously vaccinated intradermally. Adverse reactions were not serious or severe. The intramuscular route is recommended as the procedure of choice when vaccinating against hepatitis B.

The maternal-infant center in the control of hepatitis B.

A seroepidemiologic survey of HBV infection was carried out in four population groups served by the Maternity Hospital of Majorca, an island in the Mediterranean. The prevalence of HBV markers (HBsAg, anti-HBs, anti-HBc), determined by enzyme-immunoassay, reached 17.2% among 864 parturients, 17.2% in 783 hospital personnel, 2.7% and 19.2% among the 186 children and 73 husbands of parturients with no HBV markers, 22.8% and 43.8%, respectively, among the 44 children and 48 husbands of HBsAg chronic carrier parturients. The prevalences of HBsAg in the same groups reached 0.9%, 1.5%, 0% and 0%, 11.4% and 2.1%, respectively. The carrier state represents 50% of all infection cases among children and 4.8% among husbands of carrier women. The prevalence of markers, which was especially high among personnel working in maintenance services (39.1%), on surgical wards (35.3%), among midwives (27.6%) and in cleaning and laundry services (27.1%), and laboratories (21.4%), is used as an indicator in defining priorities for the vaccination of people at risk. Sixty-seven newborn babies of HBsAg carrier mothers were administered one dose of HBIG and three doses of hepatitis B vaccine; at 12 months of age, the seroconversion rate was 98.5%, whereas 1 child (1.5%) became a chronic carrier. Maternity hospitals represent the ideal centers in which to carry out the detection of HBsAg in pregnant women prior to parturition, to ensure that all newborns of chronic carrier women receive passive-active immunization, and to screen their family contacts and vaccinate those who are found susceptible to the infection.