Patricia Volkow

Protection of breast-fed infants against Campylobacter diarrhea by antibodies in human milk

To investigate the role of breast-feeding in preventing diarrhea caused by Campylobacter jejuni , we followed 98 Mexican children prospectively for 2 years beginning at their birth. Attack rates of diarrhea in children less than 6 months of age who were not fed human milk were 2.3 times greater than those in children of the same age who were fed human milk. Breast-fed children remained free of diarrhea for a longer time than non-breast-fed children ( p C. jejuni for non-breast-fed infants was significantly greater ( p C. jejuni were high in colostrum, decreased during the first month of breast-feeding, and generally persisted throughout lactation. Human milk consumed by children in whom Campylobacter diarrhea developed did not contain secretory IgA antibodies to the glycine acid-extractable common antigen of Campylobacter . This study shows an association between Campylobacter antibodies in human milk and prevention of diarrhea caused by Campylobacter .

Surgical site infections at the National Cancer Institute in Mexico: A case-control study***

OBJECTIVES To quantify the surgical infection rate and to identify risk factors associated with surgical site infection. METHODS We conducted a case-control study of all surgical patients between January 1, 1993, and June 30, 1994. The frequency of surgical site infection per 100 surgeries was calculated. The odds ratio (OR) was estimated by using logistic regression analysis. SETTING A 130-bed tertiary-care teaching hospital for adult patients with cancer. RESULTS The study followed 3372 surgeries. Three hundred thirteen patients had a surgical site infection (rate per 100 surgeries: 9. 30). The risk factors associated with surgical site infection were diabetes mellitus (OR = 2.5, 95% confidence interval [CI] = 1.27-4. 91), obesity (OR = 1.76, 95% CI = 1.14-2.7), presence of surgical drains for >5 and <16 days (OR = 1.84, 95% CI = 1.02-3.31), and presence of surgical drains for >/=16 days (OR = 2.14, 95% CI = 1. 0-4.6). The bacteria most frequently isolated were Escherichia coli 38 (21.8% of the total of microorganisms found), Pseudomonas sp 22 (12.6%), Staphylococcus aureus 16 (9.2%), and coagulase-negative Staphylococcus 25 (13.6%). The coexistence of other nosocomial infections was greater among the cases (OR = 1.8, 95% CI = 1.1-3.1) than in the control group. CONCLUSIONS The surgical site infection rate in our hospital is slightly higher than the rates reported for general hospitals. The risk factors associated with surgical site infection are similar to those previously reported. Diabetes mellitus, obesity, and prolonged presence of a surgical drain increased the risk of infection.

Hyperglycemia as a risk factor for surgical site infections in patients undergoing mastectomy

BACKGROUND The aim of this study was to evaluate the association between perioperative hyperglycemia and surgical site infections (SSIs) in patients undergoing mastectomy. METHODS In this nested case-control study, patients undergoing mastectomy from May 2004 to June 2006, at the National Cancer Institute (INCan), Mexico, were included. Five blood glucose values were obtained for each patient. Patients were followed prospectively by direct observation for at least 30 days. RESULTS A total of 260 patients were included. Patient characteristics were similar in cases and controls. Cases were older (>50 years) (P = .001) and were more frequently treated with concomitant chemoradiation (P < .0001) than controls. Fifty cases (23.8%) developed an SSI. At least 1 measurement of blood glucose value > or = 150 mg/dL increased the risk for SSI (odds ratio [OR] = 3.05; 95% confidence interval [CI] = 1.5 to 6.3; P = .006). Variables associated with SSI after logistic regression analysis included age >50 years (OR = 3.7; 95% CI = 1.5 to 9.2; P = .005), preoperative concomitant chemoradiation treatment (OR = 2.8; 95% CI = 1.4 to 5.8, P = .0004), and any blood glucose value > or = 150 mg/dL (OR = 2.9, 95% CI = 1.2 to 6.2; P = .02). CONCLUSION Postoperative SSI was a very frequent complication in this cohort. Our data indicate that higher blood glucose values are an independent risk factor for postoperative SSI. Preoperative concomitant chemoradiation and age > 50 years were also risk factors for developing an SSI in patients undergoing mastectomy.

Surgical Site Infections in Breast Surgery: Case-control Study

The purpose of this study was to estimate the frequency of surgical site infections (SSIs) and identify associated risk factors for each type of breast surgery at a cancer hospital. We used a nested case-control design. Between February 1, 2000 and July 31, 2000, all breast surgeries performed were recorded on a daily basis. After hospital discharge, we evaluated patients simultaneously with surgeons three times a week for 30 days or longer. The odds ratio (OR) was estimated using logistic regression analysis. The study followed 280 patients (298 wounds). Altogether, 77 SSIs were detected, for an overall SSI rate of 25.8% (77/298). For excisions, conservative surgery, and radical mastectomies the SSI rates were 1.4%, 18.0%, and 38.3%, respectively. Excisions were excluded (n = 68) for risk factor analysis. After multivariate analysis, risk factors associated with SSIs were obesity [OR 2.5, 95% confidence interval (CI) 1.2–4.3], concomitant chemotherapy and radiation (OR 2.3, 95% CI 1.2–4.3), radical surgery (OR 3.1, 95% CI 1.1–8.6), insertion of a second drain during the late postoperative period (OR 3.7, 95% CI 1.8–7.8), and drainage duration ≥ 19 days (OR 2.9, 95% CI 1.5–5.6). The bacteria most frequently isolated were Pseudomonas aeruginosa (n = 18), Serratia sp. (n = 18), Staphylococcus aureus (n = 10), and Staphylococcus epidermidis (n = 10). Poor compliance with infection control practices and wound management was detected throughout the study period. The overall frequency of SSIs for mastectomies was higher than the reported rates, which was principally related to the more radical surgery required for advanced-stage disease, preoperative irradiation, and inadequate wound and drain care.

Life-threatening exacerbation of Kaposi's sarcoma after prednisone treatment for immune reconstitution inflammatory syndrome.

The recovery of immune functions after the initiation of HAART has been associated with clinical deterioration despite control of immunological and virological parameters, a condition that is now termed ‘immune reconstitution inflammatory syndrome’ (IRIS) [1]. The most common IRIS-associated diseases are mycobacterial, cytomegalovirus, and herpes-associated conditions, including Kaposi’s sarcoma (KS) [1–3]. IRIS conditions associated with mycobacterial infections [4], retinal cytomegalovirus [5], cryptoccocal meningitis [6], and herpes zoster [7], have been treated with primary anti-infective therapy, the continuation of HAART and anti-inflammatory therapy, usually steroids, with varying degrees of success.

Surveillance, control, and prevention of surgical site infections in breast cancer surgery: A 5-year experience

BACKGROUND We analyzed variations in surgical site infections (SSIs) during 5 years of a prospective surveillance program and investigated possible contributors to SSIs in a cohort of patients who underwent surgery for breast cancer. METHODS All breast surgeries performed between January 2001 and December 2005 were registered. Patients were followed-up by direct observation for at least 30 days under standardized conditions. The main outcome studied was SSI. A case-control analysis was conducted to identify SSI-associated risk factors and to evaluate SSI variations by means of a control chart. RESULTS During the study period, a total of 2338 breast cancer surgeries were recorded, and 441 SSIs (18.9%) were diagnosed. SSI frequency varied across the 5-year period, with a sharp decline seen after the introduction of preventive policies. After 2002, 3 out-of-confidence limits of SSIs were observed, 2 related to the use of evacuation systems and 1 associated with a group of rotating residents. Concomitant preoperative chemoradiation (odds ratio [OR]=3.47; 95% confidence interval [CI]=2.51 to 4.80), hematoma (OR=3.05; 95% CI=1.70 to 5.52), age > or = 58 years (OR=1.83; 95% CI=1.27 to 2.65), body mass index > or = 30.8 (OR=1.58; 95% CI=1.14 to 2.18), and duration of surgery > or = 160 minutes (OR=1.73; 95% CI=1.20 to 2.50) were found to be SSI-associated risk factors. CONCLUSIONS After 5 years of a continuous prospective surveillance program, we were able to decrease the rate of SSIs in patients undergoing breast cancer surgery (from 33.3% in 2000 to 18.9% in 2005), identify SSI-associated risk factors, and improve the quality of care delivered to these patients.

Paid donation and plasma trade: unrecognized forces that drive the AIDS epidemic in developing countries.

The commercial plasma industry and blood trade can fuel the transmission of HIV in a community by the most efficient way in which HIV is transmitted: the parenteral route. Paid donors get infected at the time of donation through practices like the re-use of needles, and/or injecting human blood. Paid donors from developing countries are a major source for plasma used by the pharmaceutical industry, that in 1999 fractionated 26 million litres. Paid donors also constitute an important source of blood for local use, contributing to rapid transmission of HIV through blood transfusion. This happened in Mexico in the 1980s and more recently in China. This route of HIV transmission can be efficiently prevented through a global safe blood programme and there is an urgent need to combat the epidemic.

Surgical site infection (SSI) rates among patients who underwent mastectomy after the introduction of SSI prevention policies.

OBJECTIVE To describe the results of an intervention program to reduce the rate of surgical site infection (SSI) in the breast tumor department of a referral teaching hospital for patients with cancer. METHODS Preventive measures introduced in the Breast Tumor Department of the study hospital included the following: starting in July 2000, use of sterile technique for wound care; starting in 2001, use of closed antireflux silicone evacuation systems, use of perioperative antimicrobial prophylaxis, provision of feedback to surgeons, and remodeling of the ambulatory wound care clinic. We conducted surveillance of all patients who underwent mastectomy between February 1 and December 31, 2001, and the SSI rate was calculated. A case-control analysis was performed for risk factors known to be associated with SSI. Results were compared with the data from 2000. RESULTS The study included data on 385 surgeries. SSIs were registered in 52 (13.7%) of these 385, which was a rate 58.6% less than the 2000 infection rate (33.1%). Risk factors associated with SSI included concomitant chemotherapy and radiation therapy (OR, 3.6 [95% confidence interval {CI}, 1.9-7.1]), surgery performed during an evening shift (OR, 1.9 [95% CI, 1.1-3.6]), and insertion of a second drainage tube during the late postoperative period (OR, 2.8 [95% CI, 1.4-5.7]). The mean number (+/- SD) of postoperative visits to the outpatient wound care clinic was reduced from 11.6+/-7.1 in 2000 to 9.2+/-4.4 in 2001 (P<.001, Students t test). The mean number of days that the evacuation systems were used was reduced from 19.0 to 16.0 days (P=.001, Students t test). CONCLUSIONS Continuous wound surveillance, along with feedback to surgeons, use of closed antireflux evacuation systems, and standardized practices in wound and drainage-tube care, decreased by 58.6% the rate of SSI in a breast surgical department with high rates of infection.

A Cross-Sectional Study of Prisoners in Mexico City Comparing Prevalence of Transmissible Infections and Chronic Diseases with That in the General Population

Objectives To describe patterns of transmissible infections, chronic illnesses, socio-demographic characteristics and risk behaviors in Mexico City prisons, including in comparison to the general population, to identify those currently needing healthcare and inform policy. Materials and Methods A cross-sectional study among 17,000 prisoners at 4 Mexico City prisons (June to December 2010). Participation was voluntary, confidential and based on informed consent. Participants were tested for HIV, Hepatitis B & C, syphilis, hypertension, obesity, and, if at risk, glucose and cholesterol. A subset completed a questionnaire on socio-demographic characteristics and risk behaviors. Positive results were delivered with counseling and treatment or referral. Results 76.8% (15,517/20,196) of men and 92.9% (1,779/1,914) of women participated. Complete data sets were available for 98.8%. The following prevalence data were established for transmissible infections: HIV 0.7%; syphilis: Anti-TP+/VDRL+ 2.0%; Hepatitis B: HBcAb 2.8%, HBsAg 0.15%; Anti-HCV 3.2%. Obesity: 9.5% men, 33.8% women. Compared with national age- and sex-matched data, the relative prevalence was greater for HIV and syphilis among women, HIV and Hepatitis C in men, and all infections in younger participants. Obesity prevalence was similar for women and lower among male participants. The prevalence of previously diagnosed diabetes and hypertension was lower. Questionnaire data (1,934 men, 520 women) demonstrated lower educational levels, increased smoking and substance use compared to national data. High levels of non-sterile tattooing, physical abuse and histories of sexual violence were found. Conclusion The study identified that health screening is acceptable to Mexico City prisoners and feasible on a large-scale. It demonstrated higher prevalence of HIV and other infections compared to national data, though low rates compared to international data. Individual participants benefited from earlier diagnosis, treatment and support. The data collected will also enable the formulation of improved policy for this vulnerable group.

Molecularly targeted therapy for Kaposi's sarcoma in a kidney transplant patient: case report, "what worked and what did not"

BackgroundImatinib is a tyrosine-kinase inhibitor; for which there is limited information regarding its effects on AIDS Kaposis sarcoma and none in patients with transplant-associated Kaposis sarcoma. Sirolimus, an immunosuppressive drug used for kidney transplant, exhibits antiangiogenic activity related to impaired production of VEGF (vascular endothelial growth factor), clinical benefit has been reported in Kaposis sarcoma associated with renal graft.Case PresentationHere we report a case of an 80 year old male, who developed Kaposis Sarcoma nine months after receiving a living non-related donor kidney transplant at age 74. Three years after treatment with different chemotherapeutic agents for progressive cutaneous Kaposis Sarcoma with no visceral involvement, he was prescribed Imatinib (200 mg/day for two weeks followed by 400 mg/day) after four weeks of treatment he developed anasarca, further progression of KS and agranulocytosis. Imatinib was discontinued and there was significant clinical recovery. One year later his immunosuppressive therapy was changed to Sirolimus and regression of the Kaposis sarcoma occurred.ConclusionThe lack of benefit and severe toxicity associated with the use of Imatinib in this patient should alert clinicians of potentially adverse consequence of its use in patients with transplant associated Kaposis sarcoma. On the other hand the positive response seen in this patient to Sirolimus even after a long evolution of Kaposis sarcoma, multiple chemotherapy regimens and extensive cutaneous disease further suggest it therapeutical utility for transplant associated Kaposis sarcoma.