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.

[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.

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+.

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.

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.

[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 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.

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.

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.

[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.