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Caracas, Venezuela

De Noya B.A.,Institute Medicina Tropical | De Noya B.A.,Central University of Venezuela | Diaz-Bello Z.,Institute Medicina Tropical | Colmenares C.,Institute Medicina Tropical | And 16 more authors.
Journal of Infectious Diseases | Year: 2010

Background. Trypanosoma cruzi oral transmission is possible through food contamination by vector s feces. Little is known about the epidemiology and clinical features of microepidemics of orally acquired acute Chagas disease (CD). Methods. A case-control, cohort-nested, epidemiological study was conducted during an outbreak of acute CD that affected a school community. Structured interviews were designed to identify symptoms and sources of infection. Electrocardiograms were obtained for all patients. Specific serum antibodies were assessed by immunoenzimatic and indirect hemagglutination tests. In some cases, parasitemia was tested directly or by culture, animal inoculation, and/or a polymerase chain reaction technique. Results. Infection was confirmed in 103 of 1000 exposed individuals. Of those infected, 75% were symptomatic, 20.3% required hospitalization, 59% showed ECG abnormalities, parasitemia was documented in 44, and 1 child died. Clinical features differed from those seen in vectorial transmission. The infection rate was significantly higher among younger children. An epidemiological investigation incriminated contaminated fresh guava juice as the sole source of infection. Conclusions. This outbreak was unique, because it affected a large, urban, predominantly young, middle-class, otherwise healthy population and resulted in an unprecedented public health emergency. Rapid diagnosis and treatment avoided higher lethality. Food-borne transmission of T. cruzi may occur more often than is currently recognized. © 2010 by the Infectious Diseases Society of America. All rights reserved. Source

Sanchez-Borges M.,Centro Medico Docente La Trinidad | Caballero-Fonseca F.,Centro Medico Docente La Trinidad | Capriles-Hulett A.,Centro Medico Docente La Trinidad | Gonzalez-Aveledo L.,Centro Medico Of Caracas
Pharmaceuticals | Year: 2010

After beta lactam antibiotics, hypersensitivity reactions to nonsteroidal anti-inflammatory drugs are the second cause of hypersensitivity to drugs. Acute manifestations affect the respiratory tract (aspirin exacerbated respiratory disease), the skin (urticaria and angioedema), or are generalized (anaphylaxis). Correct diagnosis and treatment in order to prevent unnecessary morbidity and the potential risk of death from these severe reactions, and to provide proper medical advice on future drug use frequently requires the participation of allergology specialists familiar with these clinical conditions. © 2010 by the authors. Source

Sanchez-Borges M.,Clinica El Avila | Sanchez-Borges M.,Centro Medico Docente La Trinidad | Caballero-Fonseca F.,Centro Medico Docente La Trinidad | Capriles-Hulett A.,Centro Medico Docente La Trinidad | Gonzalez-Aveledo L.,Centro Medico Of Caracas
Journal of the European Academy of Dermatology and Venereology | Year: 2015

Background A subset of patients with chronic spontaneous urticaria (CSU) experience disease exacerbations after receiving non-steroidal anti-inflammatory drugs (NSAIDs). This condition has been designated as Aspirin-Exacerbated Cutaneous Disease (AECD). Objectives The purpose of this study was twofold: (i) Investigate the demographic and clinical features of patients affected by AECD; (ii) To compare patients with AECD and NSAID-tolerant CSU patients for those characteristics. Methods Patients with AECD and a group of unselected CSU patients tolerant to NSAIDs were studied. Demographic and clinical data were obtained by direct questioning and physical examination. Laboratory investigations and allergen skin prick tests were performed only in selected patients, as guided by the medical history. Results Of 423 CSU patients admitted in the clinics, 52 (12.2%) had AECD. Compared with NSAID-tolerant CSU patients, AECD patients had significantly longer disease duration (57.7 ± 118.4 vs. 24.4 ± 36.6 months, P < 0.05), higher prevalence of angio-oedema (72.7 vs. 30.9%, P < 0.05) and atopy (83.8% vs. 58.4%, P < 0.05) and more frequent involvement of the face and upper respiratory tract (54.5% vs. 29.6%, P < 0.05). Conclusions AECD is a distinct phenotype that should be considered for inclusion as a separate subtype of chronic spontaneous urticaria. © 2014 European Academy of Dermatology and Venereology. Source

Capriles Hulett A.,Centro Medico Of Caracas | Yibirin M.G.,LETI Laboratories | Garcia A.,General Practitioner | Hurtado D.,Centro Medico Docente
World Allergy Organization Journal | Year: 2014

Results: Eighty-eight asthmatic patients were enrolled, between children and adults. Groups were comparable in: demographic data, previous use of other medications, ACT scores, pulmonary functions (Wright Peak Flow meter), allergy status (Skin Prick Test) as well as adherence to the prescribed Montelukast treatment. By an intention to treat (ITT), a total of 64 patients were included for analysis. For the three and six months time points the difference between placebo and Montelukast was found to be significant (p < 0.03 and p < 0.04, respectively). Such trends continued for the rest of the year, but without statistical significance, due to patient attrition.Background: Asthma affects mainly Venezuela's urban and poor majority. Exacerbations bring about a high demand in health services, thus becoming a significant public health problem. In general, asthma control programs (GINA) with use of inhaled steroid medications have proven effective, although their implementation in real life remains cumbersome. Montelukast could be a useful and practical tool for these deprived socioeconomic sectors.Methods. This real-life pilot study was conducted in a prospective, double blinded, placebo-controlled manner with randomized and parallel groups. Asthmatics that had never used leukotriene modifiers were recruited and followed-up every three months. The main outcome was the number of exacerbations meriting use of nebulized bronchodilators administered by the health care system.Conclusions: This real-life pilot study shows that a simplified strategy with oral Montelukast was practical and effective in controlling exacerbations in an asthmatic population of a vulnerable community from Caracas. Such an approach reinforces the role of primary care in asthma treatment. © 2014 Capriles Hulett et al.; licensee BioMed Central Ltd. Source

Isturiz R.E.,Centro Medico Of Caracas
International Journal of Antimicrobial Agents | Year: 2010

Antibiotics are universally prescribed drugs. Because they exert selective pressure and because of the innate bacterial ability for adaptation, even the appropriate clinical use of these potentially life-preserving agents inevitably fosters the development and spread of resistance by a variety of microorganisms. Inappropriate use has accelerated and increased the magnitude of a problem that is now considered a public health crisis. For Gram-positive pathogens some compounds offer limited hope, but for Gram-negative organisms no new drugs with radically increased spectra are available for clinical trials. Patients with serious infections due to multiresistant organisms are experiencing adverse, sometimes fatal, clinical outcomes. Use of multiple drugs increases side effects and exposes additional susceptible bacteria to selective pressure. There is evidence that the appropriate use of currently available antibiotics can be associated with a reduction of the spread of resistance. Antibiotic stewardship programmes and the antibiotic 'care bundle' approach can be effective measures to lengthen the useful life of antibiotics and can be implemented in most clinical situations. © 2010 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved. Source

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