Examinando por Autor "Marchena Picado, Margarita"

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Clostridium difficile outbreak in Costa Rica: control actions and associated factors
(Los autores, 2012) Wong McClure, Roy; Guevara Rodríguez, Moraima; Abarca Gómez, Leandra; Solano Chinchilla, Antonio; Marchena Picado, Margarita; O’Shea, Michele; Badilla Vargas, Xiomara
Objective. To describe interventions implemented during a nosocomial outbreak of Clostridium difficile in a general hospital in Costa Rica from December 2009 to April 2010 in order to achieve outbreak control and the factors determined to be associated with C. difficile infection. Methods. Laboratory-confirmed cases of C. difficile were analyzed to describe the outbreak pattern and intervention measures implemented. Cases were selected and recruited in a casecontrol study. Controls were selected from the same services and time period as the cases. Evaluated exposures included underlying medical conditions and treatments administered before the onset of symptoms. Results. The mean ages in case and control groups were 62.3 and 55.3 years, respectively. Control measures included a hand-hygiene campaign, deep disinfection of hospital surfaces, strict isolation of cases, use of personal protection equipment, and restriction of antibiotic use. The adjusted attributable risks associated with the outbreak were diabetes [odds ratio (OR) 3.4, 95% confidence interval (CI) 1.5–7.7], chronic renal failure (OR 9.0, 95% CI 1.5–53.0), and prescribing ceftazidime (OR 33.3, 95% CI 2.9–385.5) and cefotaxime (OR 20.4, 95% CI 6.9–60.3). Conclusions. Timely implementation of control measures resulted in reduced infection transmission and successful control of the outbreak. Conditions associated with C. difficile infection were similar to those found in previously described outbreaks of this bacterium.
Síndrome aglutininas frías
(Colegio de Médicos y Cirujanos de Costa Rica, 2004-12) Quintanilla Gallo, Júvel; Marchena Picado, Margarita; Gourzong Taylor, Charles
El síndrome de aglutininas frías es una forma de anemia hemolítica autoinmune poco común. Fue descrito por primera vez hace más de un siglo. En ésta entidad, la lisis de los glóbulos rojos es mediada por la activación del complemento, pero mayormente interviene la fagocitosis por el sistema retículo endotetial. Esta hemólisis ocurre a temperaturas inferiores a 3rC. La presentación puede ser idiopática o secundaria y su tratamiento está relacionado con la causa de fondo. A continuación se presenta el caso de una paciente de 80 años con anemia hemolítica y síntomas respiratorios asociados al uso ambulatorio de antibióticos, cuyos resultados de laboratorio mostraron títulos aItos de aglutininas frías