ABSTRACT
BACKGROUND: Infections caused by Candida are an emerging pathology on surgical wards. The aim of the present study was to evaluate the incidence, characteristics, and predictive factors of mortality in patients colonized and/or infected by Candida spp. in this setting. METHODS: A consecutive series of 105 patients hospitalized on a general surgery ward between 2000 and 2004 were included, and 118 positive cultures for Candida were identified. The variables age, sex, previous medical history, current disease, anemia, ICU stay, type and localization of the microorganism, need for parenteral nutrition, and transfusions were recorded. The primary outcome was in-hospital mortality. A univariate analysis was performed to determine which of these variables were associated with mortality. With a logistic regression model, independent prognostic factors of mortality were determined. RESULTS: The prevalence of patients colonized and/or infected by Candida on our surgical ward was 0.98% (CI 95%: 0.79-1.17), and the incidence was 49 cases per 1,000 patient-years. Of the 105 patients in this series, 56 were men (53%) and 49 women (47%); the mean age was 63.8 years (SD +/- 15.7). Twelve patients (11.4%) had candidemia. Crude mortality was 23% (24 patients), whereas the mortality attributable to candidemia was 25% (3/12 cases). Anemia (p = 0.001); transfusions (p = 0.003), and an ICU stay (p = 0.002) were associated with mortality. Candidemia was associated with neoplasms (p = 0.02) and the infection caused by Candida parapsilosis (p = 0.04). The only independent factor related to mortality was the anemia (p = 0.028; Odds Ratio: 6.43; 95% CI: 1.23-33.73). CONCLUSIONS: Colonization and/or infection by Candida spp. in non-ICU hospitalized surgical patients implies a relative high mortality. Anemia is an independent factor for mortality.
Subject(s)
Candida/isolation & purification , Candidiasis/microbiology , Candidiasis/mortality , Cross Infection/microbiology , Cross Infection/mortality , General Surgery , Adult , Aged , Aged, 80 and over , Candidiasis/epidemiology , Chi-Square Distribution , Cross Infection/epidemiology , Female , Hospital Mortality , Humans , Incidence , Logistic Models , Male , Middle Aged , Prevalence , Prognosis , Retrospective Studies , Risk FactorsABSTRACT
Primary pulmonary hypertension (PPH) is a disease of un-known etiology that is characterized by an increase in pulmonary arterial pressure. Traditionally its treatment has been based on the administration of the vasodilator therapy with calcium channel blockers. At present there are some treatments which not only correct the vasoconstriction but also other pathogenic PPH associated effects, such a vascular remodelling and the thrombosis. These treatments include: a) analogs of prostacyclin with different administration routes; b) endothelin-receptor antagonists; and c) drugs that affect the metabolic pathway of nitric oxide. These pharmacological advances have reduced the number of pulmonary transplants in the patients with HPP, which is the last therapeutic alternative.
Subject(s)
Hypertension, Pulmonary/therapy , Amphetamines/adverse effects , Cardiovascular Agents/therapeutic use , Endothelin Receptor Antagonists , Endothelium, Vascular/physiopathology , Heart Failure/etiology , Humans , Hypertension, Pulmonary/drug therapy , Hypertension, Pulmonary/etiology , Hypertension, Pulmonary/physiopathology , Hypertension, Pulmonary/surgery , Lung Transplantation , Nitric Oxide/physiology , Piperazines/therapeutic use , Prostaglandins I/therapeutic use , Pulmonary Artery/pathology , Purines , Sildenafil Citrate , Sulfones , Thrombosis/etiology , VasoconstrictionABSTRACT
Plasmatic coagulation has like purpose the formation of a stable clot of fibrina, this process is possible thanks to the intervention of the factors of the coagulation that are plasmatic proteins. Some of these factors are vitamin K dependent (factors II, VII, IX and X) and all except for the factors VIII, XII and XIII which are synthesized in the liver. Three clinical cases of patients are described who present serious hemorrhagic disorders, associated to different hepatic alterations, which do not respond to conventional treatments. As a measure of urgency and therapeutic alternative, the administration of recombinant factor VII is used with the aim of activating the extrinsic pathway of the coagulation and of obtaining a positive answer in the control of the hemorrhage.
Subject(s)
Factor VII/therapeutic use , Hemorrhage/drug therapy , Adult , Breast Neoplasms/complications , Female , Hemorrhage/etiology , Humans , Liver/injuries , Liver Diseases/complications , Liver Diseases, Alcoholic/complications , Male , Middle Aged , Recombinant Proteins/therapeutic useABSTRACT
La coagulación plasmática tiene como finalidad la formación de un coágulo estable de fibrina. Este proceso es posible gracias a la intervención de los factores de la coagulación que son proteínas plasmáticas. Algunos de estos factores son dependientes de vitamina K (factores II, VII, IX y X) y todos a excepción de los factores VIII, XII y XIII se sintetizan en el hígado. Se describen tres casos clínicos de pacientes que presentan trastornos hemorrágicos graves, asociados a distintas alteraciones hepáticas, que no responden a tratamientos convencionales. Como medida de urgencia y alternativa terapéutica se recurre a la administración de factor VII recombinante, con el objetivo de activar la vía extrínseca de la coagulación y obtener una respuesta positiva en el control de la hemorragia La coagulación plasmática tiene como finalidad la formación de un coágulo estable de fibrina. Este proceso es posible gracias a la intervención de los factores de la coagulación que son proteínas plasmáticas. Algunos de estos factores son dependientes de vitamina K (factores II, VII, IX y X) y todos a excepción de los factores VIII, XII y XIII se sintetizan en el hígado. Se describen tres casos clínicos de pacientes que presentan trastornos hemorrágicos graves, asociados a distintas alteraciones hepáticas, que no responden a tratamientos convencionales. Como medida de urgencia y alternativa terapéutica se recurre a la administración de factor VII recombinante, con el objetivo de activar la vía extrínseca de la coagulación y obtener una respuesta positiva en el control de la hemorragia (AU)
