Jimenez J.N.,University of Antioquia |
Ocampo A.M.,University of Antioquia |
Vanegas J.M.,University of Antioquia |
Rodriguez E.A.,University of Antioquia |
And 10 more authors.
International Journal of Medical Microbiology | Year: 2013
Most studies on Staphylococcus aureus have focused on the molecular epidemiology of methicillin-resistant S. aureus (MRSA) infections. In contrast, little information is available regarding the molecular epidemiology of currently circulating methicillin-susceptible S. aureus (MSSA) isolates in hospital settings, an epoch when the epidemiology of S. aureus has undergone significant changes. We conducted a cross-sectional study to compare the clinical, epidemiological, and genetic characteristics of MSSA and MRSA isolates at 3 tertiary-care hospitals in Medellín, Colombia, from February 2008 to June 2010. The infections were classified according to the Centers for Disease Control and Prevention (CDC) definitions. Genotypic analysis included spa typing, multilocus sequence typing (MLST) and staphylococcal cassette chromosome (mec) (SCC. mec) typing. A total of 810 patients was enrolled. One hundred infections (12.3%) were classified as community-associated (31 CA-MSSA, 69 CA-MRSA), 379 (46.8%) as healthcare-associated community-onset (136 HACO-MSSA, 243 HACO-MRSA), and 331 (40.9%) as healthcare-associated hospital-onset (104 HAHO-MSSA, 227 HAHO-MRSA). Genotype analyses showed a higher diversity and a more varied spa type repertoire in MSSA than in MRSA strains. Most of the clinical-epidemiological characteristics and risk factors evaluated did not allow for discriminating MRSA- from MSSA-infected patients. The lack of equivalence among the genetic backgrounds of the major MSSA and MRSA clones would suggest that the MRSA clones are imported instead of arising from successful MSSA clones. This study emphasizes the importance of local surveillance to create public awareness on the changing S. aureus epidemiology. © 2013 Elsevier GmbH.
PubMed | Clinica Medellin, University of Saskatchewan, Institute Alta Tecnologia Medica IATM, Hospital Universitario San Vicente Fundacion and University of Antioquia
Type: Journal Article | Journal: Revista de investigacion clinica; organo del Hospital de Enfermedades de la Nutricion | Year: 2016
Magnetic resonance imaging is an essential tool in the pre-surgical evaluation of patients with drug-resistant epilepsy.Our aim was to assess the value of re-imaging patients with focal drug-resistant epilepsy.Thirty patients with negative or non-conclusive 1.5 Tesla magnetic resonance imaging were rescanned with 1.5T and 3T. All of them had previous 1.5 scans with no seizure protocol in a non-specialized center. Two neuroradiologists who were blinded to prior imaging results randomly reviewed the magnetic resonance images. Kappa score was used to assess the reliability.Mean age of patients was 30 (SD 11) years. The intra-observer agreement for the first radiologist was 0.74 for 1.5T and 0.71 for 3T. In the second radiologist it was 0.82 and 0.66, respectively. Three lesions (10%) were identified by general radiologists in non-specialized centers using a 1.5T standard protocol. In our center a consensus between two neuroradiologists using epilepsy protocol identified seven lesions (23%) using 1.5T and 10 (33%) using 3T (p < 0.01). In 28% of patients this additional information resulted in a change in clinical management.3T magnetic resonance imaging rescanning improves the diagnostic yield in patients with focal epilepsy and previous negative 1.5T magnetic resonance imaging. Use of 3T magnetic resonance imaging, epilepsy protocols, and interpretation by experienced neuroradiologists is highly recommended.
Keynan Y.,University of Manitoba |
Rueda Z.V.,Pontifical Bolivarian University |
Aguilar Y.,University of Antioquia |
Trajtman A.,University of Manitoba |
And 2 more authors.
Cytokine | Year: 2015
We wanted to investigate the pro-inflammatory cytokine/chemokine profile associated with the etiological agents identified in HIV patients. Immunosuppressed patients admitted to two hospitals in Medellin, Colombia, with clinical and radiographic diagnosis of pneumonia were enrolled in the study. After consent, bronchoalveolar lavage (BAL) was collected for bacterial, mycobacterial and fungal diagnosis. All patients were followed for a year. A stored BAL sample was used for cytokine/chemokine detection and measurement using commercial, magnetic human cytokine bead-based 19-plex assays. Statistical analysis was performed by assigning cytokine/chemokine concentrations levels into <25 percentile (lower), 25-75 percentile (normal) and >75 percentile (higher). Principal component analysis (PCA) and Kruskal-Wallis analysis were conducted to identify the clustering of cytokines with the various infectious etiologies (fungi, Mycobacterium tuberculosis - MTB. , and bacteria). Average age of patients was 35, of whom 77% were male, and the median CD4 count of 33. cells/μl. Of the 57 HIV infected patients, in-hospital mortality was 12.3% and 33% died within a year of follow up. The PCA revealed increased IL-10, IL-12, IL-13, IL-17, Eotaxin, GCSF, MIP-1α, and MIP-1β concentrations to be associated with MTB infection. In patients with proven fungal infection, low concentrations of IL-1RA, IL-8, TNF-α and VEGF were identified. Bacterial infections displayed a distinct cytokine pattern and were not misclassified using the MTB or fungi cytokine patterns (p-value. <. 0.0001). Our results indicate a unique pattern of pro-inflammatory cytokine/chemokine, allowing differentiation between bacterial and non-bacterial pathogens. Moreover, we found distinct, if imperfectly discriminatory, cytokine/chemokine patterns associated with MTB and fungal infections. © 2015 Elsevier Ltd.
Effect of early nutritional intervention in the aoutcome of patients at risk clinical nutrition [Efecto de la intervención nutricional temprana en el resultado clínico de pacientes en riesgo nutricional]
Montoya S.M.,Hospital Universitario San Vicente Fundacion |
Munera Garcia N.E.,University of Antioquia
Nutricion Hospitalaria | Year: 2014
Introduction: Hospital malnutrition is a multi-causal process and high prevalence. Nutritional intervention at an early stage improves prognosis of affected patients. Objective: To compare the effect of early nutritional intervention with a routine care on clinical outcome in patients with detected nutritional risk screening tool NRS Nutritional Risk Screening 2002, entering an institution of complex health. Materials and Methods: A quasi-experimental study. Was assessed in the first 48 hours of admission to 891 patients, of whom 247 were at nutritional risk, 116 were the routine care group and 54 the intervention group. We evaluated complications, hospital stay, weight loss, change in body mass index and protein-calorie adequacy. Results: Patients undergoing caloric intake had higher (1617 ± 444.5 vs 1366 ± 467.1 kcal, p = 0.002) and protein (1.2 ± 0.2 vs 0.9 ± 0.3 g, p = 0.000), average weight gain of 0.7% vs a loss of 2.3% (p = 0.000), a proportion of moderate complications 8.2% vs 25.2% (p = 0.012) and decreased time hospital stay of 2.2 days (p = 0.138) compared with routine care group. Conclusion: Early nutritional intervention in patients at nutritional risk decreased the proportion of moderate complications, improved the adequacy of energy, protein and nutritional evolution in terms of weight gain and change in BMI. The length of stay did not differ significantly.
Escobar P. R.M.,Hospital Universitario San Vicente Fundacion |
Restrepo J. M.,University of Antioquia
Revista Colombiana de Gastroenterologia | Year: 2015
Benign esophageal strictures are a common cause of medical consultation and gastroenterological endoscopy. Usually, given their non-neoplastic nature, they have been managed with recurrent endoscopic dilation which is uncomfortable for the patient and which generates high costs due repetition. In addition, there is always the risk of esophageal perforation at every session. The use of esophageal stents for management of benign esophageal strictures is becoming increasingly more common and is promising for various etiologies. We present a case of a benign esophageal stricture secondary to infection with histoplasma capsulatum which was managed entirely with a completely covered metal stent. This led to complete resolution of the obstruction. © 2015 Asociaciones Colombianas de Gastroenterología, Endoscopia digestiva, Coloproctología y Hepatología.
Senior Sanchez J.M.,University of Antioquia |
Senior Sanchez J.M.,Hospital Universitario San Vicente Fundacion
Iatreia | Year: 2014
We describe the clinical case of a 26 year-old woman who came to Hospital Universitario San Vicente Fundación (Medellín, Colombia) with symptoms and signs of acute heart failure. She had been previously diagnosed with chronic heart failure with reduced ejection fraction without clear origin, pulmonary thromboembolism and ischemic stroke, without optimal neurohormonal modulation. She was admitted with clinical findings of fluid overload and low tissue perfusion, with inotropic support requirement and parenteral diuretics; clinical stability was achieved with the progressive introduction of medical therapy for heart failure. For the study of the latter, heart MRI was done that showed a delayed enhancement area in the left anterior descending artery. Coronary angiography was carried out in which no significant lesions were found in the epicardial arteries. Finally, compensation of the acute heart failure was achieved, and chronic anticoagulation was started for probable thrombophilic disease, due to the recurring arterial and venous thrombotic events. © 2014, Universidad de Antioquia. All rights reserved.
Rodriguez C.A.,University of Antioquia |
Agudelo M.,University of Antioquia |
Agudelo M.,Hospital Universitario San Vicente Fundacion |
Zuluaga A.F.,University of Antioquia |
And 2 more authors.
Antimicrobial Agents and Chemotherapy | Year: 2015
Therapeutic nonequivalence of generic antibiotics may lead to treatment failure and enrichment of resistance. However, there has been no demonstration that an equivalent generic displays the same resistance selection profile as the innovator drug. We aimed to test this hypothesis with five generic versions of ciprofloxacin by assessing their pharmaceutical equivalence with microbiological assays and their efficacy against Pseudomonas aeruginosa PAO1 in the neutropenic murine thigh infection model. One equivalent generic was selected for analysis by high-pressure liquid chromatography-tandem mass spectrometry (LC-MS/ MS), to confirm chemical identity, and resistance selection experiments in a hollow-fiber (HF) system simulating two clinical dosing regimens. Total and resistant populations were measured, and the MICs of the resistant cells with and without an efflux pump inhibitor were determined. LC-MS/MS found no differences between products, and the innovator and the generic selected resistance with the same magnitude and mechanism after 7 days of treatment in the HF system, supporting the fact that a generic with demonstrated equivalence in vivo is also equivalent regarding resistance selection. © 2015 American Society for Microbiology. All Rights Reserved.
Affective syndromes in liver transplant recipients: ¿mediated neurotoxicity immunosuppressive? [Síndromes afectivos en receptores de trasplante hepático: ¿neurotoxicidad mediada por inmunosupresores?]
Restrepo D.P.,CES University |
Tamayo A.,Hospital Universitario San Vicente Fundacion
Revista Colombiana de Psiquiatria | Year: 2015
Introduction The onset of affective and psychotic in liver transplant patients symptoms, raises the need to explore the possible etiologies of mental symptoms. Methodology Case report and literature review. Results Four clinical cases of patients undergoing orthotopic liver transplantation, who in the early post transplant showed affective symptoms, delusions and psychomotor agitation for which they needed psychiatric hospitalization and treatment with psychotropic drugs are presented. Three of the patients had clinical improvement and one patient died by suicide. Discussion The development of mental symptoms in the post-transplant period opens the possibility of considering the secondary organic mental disorder a basic condition. Conclusions The adverse drug reaction may explain affective mental disorders in these four cases were reported. © 2014 Asociación Colombiana de Psiquiatría. Published by Elsevier España, S.L.U. All rights reserved.
PubMed | Hospital Universitario San Vicente Fundacion and University of Antioquia
Type: Comparative Study | Journal: Hernia : the journal of hernias and abdominal wall surgery | Year: 2016
To compare the effectiveness of abdominal wall closure using the vacuum-assisted closure (NPC) as described by Barker et al. with an institutional protocol using a double polyvinyl bag in the first surgery, which is changed in subsequent surgeries to a polyvinyl bag placed over the bowel loops and a prolene mesh attached to the abdominal fascia (MMFC).Randomized controlled trial. Patients with open abdomen (OA) due to a traumatic or a medical cause were included in the study. Variables studied included demographics, indication for surgery, number of interventions, hospital length of stay (HLOS), ICU length of stay, abdominal wound care costs, complication rates, and method and time to definitive fascial closure.From June 2011 to April 2013, 75 patients were enrolled in the study. Patients who died within 48 h were excluded; therefore, 53 patients in total were assessed. NPC achieved fascial closure in 75% of patients, and MMFC achieved closure in 71.9% of patients. The closure rates in patients with OA secondary to medical causes (80% by NPC vs. 71.4% by MMFC) or traumatic causes (70% by NPC vs. 73.7% by MMFC) were similar in both treatment groups. There were no differences between the groups with respect to cause of OA, complications, length of hospital stay, or the length of stay in the intensive care unit.MMFC is a method comparable to NPC for the temporary management of OA that results in similar closure and complication rates.
PubMed | Hospital Universitario San Vicente Fundacion
Type: Journal Article | Journal: Biomedica : revista del Instituto Nacional de Salud | Year: 2016
Tuberculosis continues to be a global public health problem, the extrapulmonary form being estimated to occur in 10-20% of immunocompetent individuals, increasing in patients who are carriers of the human immunodeficiency virus (HIV); its diagnosis is difficult with conventional methods due to the paucibacillary nature of samples. The Xpert MTB/RIF test represents an important development in the molecular detection of Mycobacterium tuberculosis and has been used with a variety of non-respiratory clinical samples.To determine the effectiveness of Xpert MTB/RIF in the detection of M. tuberculosis and sensitivity to rifampicin in patients with suspected extrapulmonary tuberculosis attending Hospital Universitario de San Vicente Fundacin in Medelln in 2013-2014.This was a descriptive, cross-sectional ambispective study of 372 consecutive samples from 301 patients with suspected extrapulmonary tuberculosis, who were subjected to bacilloscopy, followed by culture in Ogawa Kudoh and the Xpert MTB/RIF molecular test.The most frequent base diagnosis (60%) for the 182 patients was infection with HIV. Using the culture as reference, the sensitivity and general specificity of the molecular test was 94% (95% CI: 83-100) and 97% (95% CI: 95-99), respectively; for bacilloscopy it was 38.71(95% CI: 19-57) and 100% (95% CI: 99-100), respectively. Sensitivities higher than 75% were found in analyses stratified by samples. Thirty-seven of the isolates were sensitive and one resistant to rifampicin.Xpert MTB/RIF performed well in samples from different tissues and liquids, representing a significant advance in support of extrapulmonary tuberculosis diagnosis in terms of time and percentage positivity.