L E Morano Amado

Hospital do Meixoeiro, Vigo, Galicia, Spain

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Publications (18)27.78 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Nosocomial infection causes a prolonged hospital stay and an increase in care costs. The objective of this study was to determine the length of stay excess and costs attributable to nosocomial bacteremia. Retrospective study of clinical records of 148 patients with nosocomial bacteremia during 1996. A matched case-control study was performed. For matching, the following parameters were used: RDG, year of admission, age 10 years, main diagnosis and number of secondary diagnoses. Costs were determined by excess length of hospital stay and calculating alternative costs. Matching was obtained for 100 cases (67.5%) and cost estimation was performed. Compared with cases, non-matched cases showed differences regarding significant issues for cost, such as hospital stay ( p = 0.01), number of empirical (p = 0.001) or definitive antibiotics (p = 0.03). The median hospital stay for cases was longer than for controls (35 vs 15.5 days, respectively; p = 0.000). When only survivor case-control pairs were considered (n = 75), cases remained in hospital for a median of 36 vs 15 days for controls (p = 0.000). Hospital stay days attributable to nosocomial bacteremia were 19.5 for all matched and 21 for matched survivor cases. Only 76% of cases had stay days attributable to bacteremia. Significant differences between cases and controls included: the mean total costs of admission (p = 0.000), cost of stay (p = 0.001), pharmaceutical expenses (p = 0.000), and cost of microbiological studies (p = 0.000), laboratory work-up (p = 0.001) and radiological studies (p = 0.000). Hospital stay represented more than 60% of costs, followed by pharmaceutical expenses. Cost differences between bacteremic patients and controls, calculated in function of stay median, was 4.424 euros (p = 0.000) and 4.744 euros (p = 0.000) for alternative costs. Ten cases showed a difference that represented more than half of the total difference. Nosocomial bacteremia represent a stay prolongation and a significant economical burden. Hospital stay and pharmaceutical expenses accounted for the most part of the associated costs. The differences in costs obtained with both methods were small. Since not all selected cases were matched, there may be an error in the appreciation of the difference between cases and controls.
    Revista Clínica Española 10/2002; 202(9):476-84. · 2.01 Impact Factor
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    ABSTRACT: A retrospective study of cases of paronychia associated with anti-retroviral therapy diagnosed in two general hospitals is here reported. Lesions appeared from 3 and 48 months after institution of therapy. At diagnosis, 84.6% of patients were on indinavir therapy. CD4 values ranged from 120 and 1,332 cells/mm3 and viral load was lower than 200 copies/ml in 92.3 of cases. Conservative therapy was applied in 7 patients and surgery in 6. In all patients indinavir therapy was discontinued, and cure was achieved 16 weeks later. The "retinoid" effect of indinavir is discussed as likely pathogenic explanation for this complications. We advocate for topic therapy and change of anti-retroviral therapy, reserving surgery for patients not responding to therapy. Pain and functional limitation caused by this non uncommon complication (1.6% of our patients treated with anti-retroviral agents) makes its knowledge necessary and an active search by clinicians in patients receiving indinavir therapy.
    Revista Clínica Española 09/2001; 201(8):455-8. · 2.01 Impact Factor
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    ABSTRACT: Acute suppurative thyroiditis is an uncommon disease due to local resistance of the gland to infection. Preexisting gland pathology and local anatomic abnormalities are predisposing factors. We present the first case described in the medical literature caused by Pasteurella spp after upper respiratory infection with insidious manifestations resembling subacute thyroiditis. The course was benign after surgical drainage.
    Anales de medicina interna (Madrid, Spain: 1984) 01/2000; 16(12):637-8.
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    ABSTRACT: To establish the time elapsed from the patient arrival to the emergency room to the beginning of antibiotic therapy. To identify etiologic factors for treatment delay. 73 patients diagnosed of bacterial meningitis in the emergency room and admitted to the hospital were studied. Patient characteristics as well as meningitis predisposing factors, symptoms, physical examination, laboratory data, radiological studies and previous ambulatory treatment, were recorded retrospectively. Arrival time, time expended at diagnostic procedures and time of administration of the first antibiotic dose, as well as the administration place were registered. Patients clinical evolution, and factors influencing the delay of antibiotic administration were analyzed. Median age was 17 years. Patient care was evenly distributed along the day, 80% had a light base risk, 29% had at least a risk factor for meningitis, 22% received antibiotic previously. Clinical presentation was classic in more than 71% of patients. Blood cultures were positive in 41%, and CSF cultures were positive in 63%, 43% of cases were related to Neisseria meningitidis, 20% Streptococcus pneumoniae and unknown bacteria in 31.5%. Computerized Tomography (CT) was performed in 9 cases. Median time from the arrival to the Emergency Room until antibiotic administration was 5 hours and 25 minutes: When antibiotics were given before Lumbar Puncture (LP), it was 2 hours and 50 minutes, 5 hours 20 minutes when therapy was started after LP, and 7 hours and 22 minutes when CT was performed before LP. The only factor showing a statistically significant relation with the time to antibiotic administration was the patient being sent by the primary care physician to the hospital with a presumptive diagnosis of bacterial meningitis (1 hour 20 minutes vs. 5 hours 51 minutes). Only a small part of bacterial meningitis cases start antibiotic treatment in the first 30 minutes. Delay is high and it increases when certain diagnostic tests are performed. Information received from the primary care physician, has the highest influence on the beginning of treatment.
    Anales de medicina interna (Madrid, Spain: 1984) 09/1999; 16(9):451-6.
  • L E Morano Amado, C Fernández Peña, M Caeiro Muñoz
    Revista Clínica Española 12/1996; 196(11):801-2. · 2.01 Impact Factor
  • Revista Clínica Española 07/1996; 196(6):407-8, 411. · 2.01 Impact Factor
  • Medicina Clínica 07/1995; 105(1):37. · 1.25 Impact Factor
  • Medicina Clínica 03/1995; 104(6):238-9. · 1.25 Impact Factor
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    ABSTRACT: We report a case of miliary tuberculosis following extracorporeal shock wave lithotripsy (ESWL*). The patient had right lower caliceal and left distal ureteral calculi on excretory urography. He was hospitalized 50 days after ESWL with fever, weight loss and night sweats. Liver function tests were abnormal and he had hypoxemia. A chest x-ray at hospitalization was normal but a miliary pattern developed 10 days later. Diagnosis was tuberculosis based on culture of sputum in a Löwenstein medium. Liver biopsy confirmed caseating epithelioid granulomas. Antituberculous treatment was successful. We conclude that renal tuberculosis associated with calcification must be ruled out before treatment with ESWL to avoid a possible hematogenous dissemination.
    The Journal of Urology 07/1993; 149(6):1532-4. · 3.75 Impact Factor
  • Medicina Clínica 03/1992; 98(6):237-8. · 1.25 Impact Factor
  • Medicina Clínica 03/1992; 98(4):155. · 1.25 Impact Factor
  • Revista Clínica Española 11/1991; 189(6):298-9. · 2.01 Impact Factor
  • Anales de medicina interna (Madrid, Spain: 1984) 11/1990; 7(10):546-7.
  • Revista Clínica Española 01/1990; 185(9):480. · 2.01 Impact Factor
  • Enfermedades Infecciosas y Microbiología Clínica 11/1989; 7(8):447. · 1.48 Impact Factor
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    ABSTRACT: Objective Nosocomial infection casuses a prolonged hospital stay and an increase in care costs. The objective of this study was to determine the length of stay excess and costs attributable to nosocomial bacteremia. Patients and Methods Retrospective study of clinical records of 148 patients with nosocomial bacteremia during 1996. A matched case-control study was performed. For matching, the following parameters were used: RDG, year of admission, age ± 10 years, main diagnosis and number of secondary diagnoses. Costs were determined by excess length of hospital stay and calculating alternative costs. Results Matching was obtained for 100 cases (67.5%) and cost estimation was performed. Compared with cases, nonmatched cases showed differences regarding significant issues for cost, such as hospital stay (p = 0.01), number of empirical (p = 0.001) or definitive antibiotics (p = 0.03). The median hospital stay for cases was longer than for controls (35 vs 15.5 days, respectively; p = 0.000). When only survivor case-control pairs were considered (n = 75), cases remained in hospital for a median of 36 vs 15 days for controls (p = 0.000). Hospital stay days attributable to nosocomial bacteremia were 19.5 for all matched and 21 for matched survivor cases. Only 76% of cases had stay days attributable to bacteremia. Significant differences between cases and controls included: the mean total costs of admisssion (p = 0.000), cost of stay (p = 0.001), pharmaceutical expenses (p = 0.000), and cost of microbiological studies (p = 0.000), laboratory work-up (p = 0.001) and radiological studies (p = 0.000). Hospital stay represented more than 60% of costs, followed by pharmaceutical expenses. Cost differences between bacteremic patients and controls, calculated in function of stay median, was 4.424 euros (p = 0.000) and 4.744 euros (p = 0.000) for alternative costs. Ten cases showed a difference that represented more than half of the total difference. Conclusions Nosocomial bacteremia represent a stay prolongation and a significant economical burden. Hospital stay and pharmaceutical expenses accounted for the most part of the associated costs. The differences in costs obtained with both methods were small. Since not all selected cases were matched, there may be an error in the appreciation of the difference between cases and controls.
    Revista Clínica Española 202(9):476–484. · 2.01 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: A retrospective study of cases of paronychia associated with anti-retroviral therapy diagnosed in two general hospitals is here reported. Lesions appeared from 3 and 48 months after institution of therapy. At diagnosis, 84.6% of patients were on indinavir therapy. CD4 valus ranged from 120 and 1,332 cells/mm3 and viral load was lower than 200 copies/ml in 92.3 of cases. Conservative therapy was aplied in 7 patients and surgery in 6. In all patients indinavir therapy was discontinued, and cure was achieved 16 weeks later. The «retinoid» effect of indinavir is discussed as likely pathogenic explanation for this complications. We advocate for topic therapy and change of anti-retroviral therapy, reserving surgery for patients not responding to therapy. Pain and functional limitation caused by this non uncommon complication (1.6% of our patients treated with antirtroviral agents) makes its knowledge necessary and an active search by clinicians in patients receiving indinavir therapy.
    Revista Clínica Española 201(8):455–458. · 2.01 Impact Factor
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    ABSTRACT: To evaluate the epidemiology, etiology, mortality and prognostic factors of bacteremia in a district hospital, we carried out a retrospective study of all blood cultures (Bc) performed in 1987 in our institution. The criteria for contamination community or hospital acquired disease, and terminal or rapidly fatal disease were those commonly accepted. Two patients were excluded owing to incomplete data. Overall 1,693 Bcs were performed; 257 of these were positive, 189 were considered as true positive (11.1%) and corresponded to 70 episodes of bacteremia (9.1/1000 admitted patients). Sixty-eight patients were included, 48 from the community and 20 of hospital origin. The male/female ratio was 43/25. There was shock in 27% of the community acquired and in 55% of the hospital acquired cases (p less than 0.1). There were no mortality differences between both groups, but there were differences in the spectrum of causative organisms. A comparison with a previous series from our institution was made. Its results shown some peculiarities of the disease in our area.
    Enfermedades Infecciosas y Microbiología Clínica 7(7):358-63. · 1.48 Impact Factor