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Biomedical subjects

A Alarcón

Publications and source records attributed to A Alarcón.

At least 19 recordsLinked to original sources
PubMed2006

Conversion from cyclosporine microemulsion to tacrolimus in stable kidney transplant patients with hypercholesterolemia is related to an improvement in cardiovascular risk profile: a prospective study.

The aim of this prospective multicenter study was to evaluate the effect of conversion from cyclosporine (CsA) to tacrolimus (Tac) on cardiovascular risk factors in stable kidney transplant patients with hyperlipidemia. Twenty-six patients were switched from CsA to Tac at 81.7 +/- 44.4 months after transplantation. Tac was started at 0.15 mg/kg/d. Patient outcomes were evaluated up to 6 months after conversion. Significant reductions were seen in systolic blood pressure (143 +/- 13 baseline to 136 +/- 9 mm Hg at 6 months, P = .026) as well as the need for antihypertensive medication, with no changes in diastolic blood pressure. There was a significant reduction in total cholesterol (247 +/- 41 to 221 +/- 35 mg/dL, P = .003), low-density lipoprotein cholesterol (150 +/- 24 to 127 +/- 27 mg/dL, P = .001), total cholesterol/high-density lipoprotein (HDL) cholesterol ratio (4.9 +/- 1.9 to 3.9 +/- 1, P = .02), and triglyceride levels (228 +/- 175 to 148 +/- 71 mg/dL, P = .026). No significant modifications in HDL cholesterol, Apo A1 and Apo-B levels, or in the need for lipid-lowering medication were observed. Glucose levels did not change, but an increase in HbAC1 took place (5.8 +/- 1.1 to 6.2 +/- 1, P = .002). In men Framingham risk score significantly decreased from 11.5 +/- 11.3 to 8.4 +/- 7.2. (P = .0023). In conclusion, elective conversion from CsA to Tac in stable kidney transplant patients with hyperlipidemia was related to an improved blood pressure and lipid profile, both suggesting a decrease in the estimated 10-year coronary heart disease risk in men.

Adult↗
PubMed2003

Brucella endocarditis: clinical, diagnostic, and therapeutic approach.

Brucella endocarditis is an uncommon focal complication of brucellosis. Presented here are 11 cases of Brucella endocarditis, all managed uniformly. The median duration of symptoms prior to diagnosis was 3 months. Five patients (45%) had underlying valvular damage, and in six (55%) endocarditis involved a normal valve. There was a predominance of aortic involvement (82%) and a high incidence of left ventricular failure (91%). Diagnostic suspicion was essential in order to test blood cultures correctly, which in this series were positive in 63% of the patients. Surgical treatment was undertaken in eight patients (72%), all with aortic involvement and left ventricular failure impossible to control with medication. One patient died during the immediate postoperative period. All the other patients received antibiotic therapy for 3 months, with no signs of relapse of the infection or malfunction of the prosthesis during a minimum follow-up period of 24 months.

Adult↗
PubMed2003

Complement component C7 deficiency in a Spanish family.

Different genetic mutations have been described in complement component C7 deficiency, a molecular defect which is clinically associated with an increased susceptibility to neisserial recurrent infections, although some cases remain asymptomatic. In this work we report the genetic bases of C7 deficiency in one Spanish family. Exon-specific PCR and sequencing revealed a novel point mutation at nucleotide 615 (exon 6) leading to a stop codon (UGG to UGA) in the patient, his mother, and sister. This transversion causes the premature truncation of the C7 protein (W183X). Additionally, we detected a missense mutation at position 1135 (exon 9) located in the first nucleotide of the codon GGG (CGG), resulting in an amino acid change (G357R) in the patient, his father, as well as in his sister. This latter mutation had been previously described in individuals from Moroccan Sephardic Jewish ancestry. Since both heterozygous mutations were found in the patient as well as in his asymptomatic sister, we analyse other meningococcal defence mechanisms such as polymorphisms of the opsonin receptors on polymorphonuclear cells. Results showed that the patient and his sister bore identical combinations of FcgammaRIIA-H/R131 and FcgammaRIIIB-NA1/2 allotypes. Our results provide further evidence that the molecular pathogenesis of C7 deficiency as well as susceptibility to meningococcal disease are heterogeneous, since different families carry different molecular defects, although many of the C7 defects appear to be homogeneous in individuals from certain geographical areas. The missense mutation G357R would make an interesting topic of analysis with regard to meningococcal disease susceptibility in the Spanish population.

Base Sequence↗
PubMed2003

[Management of human resources in neurology].

Neurology human resources comprise of the persons who make up the staff. Management tries to make the team both effective and efficient; consequently clear and quantifiable objectives together with resources according to real care needs, teaching, research and management are required. To calculate human resources, the suitability parameters recommended by scientific organisations must be used. To cover global care, 3.7 neurologists are needed for every 100,000 inhabitants. Management is the planning and selecting of staff and their incorporation into the dynamic of the team. It is also work performance training, job evaluation and the offering of opportunities to correct and improve. Personal competence is not a sufficient guarantee to ensure adequate performance. Motivation, team member encouragement to favour promotion, and support for professional career development are needed. Management is fomenting team work and stimulating staff participation in management organs, committees and hospital commissions.

Efficiency, Organizational↗
PubMed2002

[Persistence of the left superior vena cava discovered during the implantation of a hemodialysis catheter].

A persistent left superior vena cava (PLSVC) is the most common thoracic venous anomaly. It is a persistent remnant of the left anterior cardinal vein that usually disappears in early embryological development as a result of compression between the left atrium and the hilum of the left lung. If it is not associated with other congenital cardiac anomalies it is usually asymptomatic but has important clinical implications in some situations. In this article, we describe a patient with bilateral SVC identified on a chest radiograph by a haemodialysis central venous catheter passing through it.

Catheterization↗
PubMed2000

Solid-phase extraction and liquid chromatographic quantitation of quinfamide in biological samples.

This paper describes a high-performance liquid chromatographic method for the assay of quinfamide and its main metabolite, 1-(dichloroacetyl)-1,2,3,4,-tetrahydro-6-quinolinol, in plasma, urine and feces. It requires 1 ml of biological fluid, an extraction using Sep-Pack cartridges and acetonitrile for drug elution. Analysis was performed on a CN column (5 microm) using water-acetonitrile-methanol (40:50:10) as a mobile phase at 269 nm. Results showed that the assay was linear in the range between 0.08 and 2.0 microg/ml. The limit of quantitation was 0.08 microg/ml. Maximum assay coefficient of variation was 14%. Recovery obtained in plasma, urine and feces ranged from 82% to 98%.

Amebicides↗
PubMed2000

Prospective evaluation and follow-up of European patients with visceral leishmaniasis and HIV-1 coinfection in the era of highly active antiretroviral therapy.

A prospective descriptive study was designed to determine the impact of highly active antiretroviral therapy (HAART) in the evolution of visceral leishmaniasis (VL) in HIV-1 infected patients. Thirty-two patients were treated with meglumine antimoniate or amphotericin B in lipid formulations. Patients who had undergone previous HAART at study entry (n=17) continued with therapy while receiving treatment for VL. Patients who had never undergone HAART started it after VL treatment finished (n=15). Ten patients were lost to follow-up. All of the remaining patients (n=20) continued to receive HAART and were followed for an average of 441 days. Relapses were observed in 5 of 20 patients. These results indicate that HAART neither prevents the incidence of VL relapse nor modifies the clinical picture described in the pre-HAART era.

Adult↗
PubMed1999

Murine typhus as a common cause of fever of intermediate duration: a 17-year study in the south of Spain.

BACKGROUND: Fever of intermediate duration (FID), characterized by a febrile syndrome lasting from 7 to 28 days, is a frequent condition in clinical practice, but its epidemiological and etiologic features are not well described. Murine typhus (MT) is a worldwide illness; nevertheless, to our knowledge, no studies describing its epidemiological and clinical characteristics have been performed in the south of Spain. Also, its significance as a cause of FID is unknown. OBJECTIVE: To determine the epidemiological features, clinical characteristics, and prognosis of MT and, prospectively, its incidence as a cause of FID. DESIGN: Prospective study of cases of MT over 17 years (1979-1995) and of all cases of FID treated in a tertiary teaching hospital in Seville, Spain. RESULTS: One hundred and four cases of MT were included, and MT was the cause in 6.7% of 926 cases of FID. Insect bites were reported in only 3.8% of the cases of MT previous to the onset of illness. Most cases (62.5%) occurred in the summer and fall. A high frequency of rash (62.5%) was noted. Arthromyalgia (77%), headache (71%), and respiratory (25%) and gastrointestinal (23%) symptoms were also frequent. Laboratory findings were unspecific. Organ complications were uncommon (8.6%), but they were severe in 4 cases. The mean duration of fever was 12.5 days. Cure was achieved in all cases, although only 44 patients received specific treatment. CONCLUSIONS: Murine typhus is prevalent in the south of Spain and is a significant cause of FID. Clinical signs are benign, but some patients may develop severe complications. A high degree of clinical suspicion is required for diagnosis.

Adolescent↗
PubMed1999

Etiology, clinical features and outcome of splenic microabscesses in HIV-infected patients with prolonged fever.

A prospective study was conducted to determine the etiology, clinical features, and outcome in a series of 32 consecutively enrolled HIV-infected patients with prolonged fever in whom high resolution (7.5 Mhz) sonography revealed multiple splenic microabscesses. Conventional (3.5 Mhz) sonography showed no splenic abnormalities in any patients. The diagnoses were: tuberculosis (14), visceral leishmaniasis (7), disseminated Mycobacterium avium complex infection (5), Salmonella spp. bacteremia (2), lymphoma (2), disseminated Rhodococcus equi infection (1), disseminated Candida krusei infection (1) and Pneumocystis carinii pneumonia (1). Twenty-eight patients were followed up for six months and four were lost to follow-up. In 16 patients with a clinical cure and microbiological eradication, the findings on follow-up high resolution sonography were normal, and in two patients the microabscesses persisted; ten patients died. In conclusion, the findings suggest splenic microabscesses may be a frequent condition in HIV-infected patients with prolonged fever, being an unspecific manifestation of the opportunistic diseases causing fever of unknown origin in this population. They cannot be detected by conventional abdominal sonography, whereas high resolution sonography is a useful technique for their detection and follow-up.

AIDS-Related Opportunistic Infections↗
PubMed1999

Preference between two methods of active-alert hypnosis: not all techniques are created equal.

In a cross-over design (N = 80), we compared the differential liking and preference for two hypnotic techniques involving physical activity: active-alert and waking-alert (or alert-hand) procedures. Participants expressed significantly higher liking and preference for the waking-alert as compared to the active-alert procedure. The latter technique, which also had significantly lower suggestibility scores(Cardeña et al., 1998) was also associated with a significantly higher attrition rate (23%). These significant differences may be explained by the greater physical effort and difficulty associated with the active-alert technique. It seems that the waking-alert method extends the advantages of active hypnosis (e.g., alertness, enhanced self-mastery) to individuals who may dislike or are unable to cope with the greater demands required by the active-alert procedure.

Adult↗
PubMed1998

Effects on suggestibility of a new method of active-alert hypnosis: alert hand.

Research has shown that the active-alert method described by Bányai and Hilgard (1976) produces a similar increase on suggestibility as relaxation-based techniques, but it has some limitations, including the need for a stationary bicycle and a certain level of physical fitness. The authors compared that method with the new "alert hand" method, which emphasizes activity and alertness, but is simpler and less strenuous. In a repeated measures, counterbalanced design (N = 80), the authors found that (a) the alert hand method produced significantly higher objective and subjective suggestibility scores than the active-alert technique, and (b) a high percentage (23%) of volunteers discontinued participation during the active-alert method but not during the alert hand method. The alert hand method extends the benefits of active hypnosis to individuals who may have difficulties with the physical demands required by the active-alert method, and it seems to enhance suggestibility even more.

Adult↗
PubMed1998

Comparison of two methods for the assessment of delayed-type hypersensitivity skin responses in patients with human immunodeficiency virus infection.

We compared two techniques for detecting delayed-type hypersensitivity (DTH) skin responses in 359 patients infected with human immunodeficiency virus (HIV) (mean CD4+ lymphocyte count, 387/microL). DTH responses were assessed with use of two antigenic panels administered simultaneously: tuberculin purified protein derivative (PPD) plus three control antigens (Candida albicans, mumps antigen, and tetanus toxoid) administered by the Mantoux method and by a multiple-puncture device delivering seven antigens percutaneously (MULTITEST CMI; Institut Mérieux, Lyon, France). Eighty-three patients (23%) were anergic, 216 (60%) reacted to both panels, 55 (15%) did not react to MULTITEST CMI but did react to the antigens administered by Mantoux method, and only five (1%) reacted to MULTITEST CMI without reacting to antigens administered by the Mantoux method (P < .001, McNemar's test). Each of the three possible combinations of PPD plus two control antigens administered by the Mantoux method were also superior to MULTITEST CMI for classifying patients as nonanergic (P < .001, McNemar's test). We conclude that the application of antigens by the Mantoux method is more efficient than MULTITEST CMI for detecting DTH skin responses in HIV-infected patients.

Adolescent↗
PubMed1997

[Comparative study of high-frequency jet ventilation in 4 types of patients undergoing laryngeal microsurgery].

OBJECTIVE: To study high frequency jet ventilation (HFJV) in patients with chronic obstructive pulmonary disease (COPD) who are obese or who have tracheal or laryngeal stenosis, conditions which are often found in patients undergoing microsurgery of the larynx (MSL), comparing the results with those for a group of controls, patients with no stenosis who were also undergoing MSL. PATIENTS AND METHOD: Eighty patients were distributed in four groups as follows: those meeting the criteria for a diagnosis of COPD (n = 20), those who were overweight (n = 24), those with stenosis over 50% of the laryngeal opening (stenosis group, n = 10) and those with no associated pathology (control group, n = 26). HFJV was administered through a 2.2 mm internal diameter orotracheal injection catheter, using an Ergojet CVT (Temel, S.A.). The ventilatory protocol was as follows: rate 100 breaths/min, inspiratory time 30%, generator pressure (GP) 2.2 to 3.3 kg/cm2 and FiO2 70% to 90%. We analyzed the GP administered, jet volume (Vjet) delivered, maximum (PAWmax) and minimum (PAWmin) airway pressures, oxygen hemoglobin saturation (SpO2), partial pressures of O2 (pO2) and CO2 (pCO2) in arterial blood, and end-tidal pressure of CO2 (PETCO2) at baseline and 10 and 20 min after the start of HFJV. Because monitoring was invasive, the study was designed for a small series of patients and we believe it should not be generalized to include all patients undergoing MSL under normal conditions. RESULTS: HFJV had to be abandoned and conventional ventilation used in 4 patients (2 in the COPD group and 2 in the obese group). Ventilation was judged adequate in the remaining patients, with the observations that in the COPD group, pO2 levels were lower than in the control group at the 10 min readings and pCO2 levels were higher at both the 10 and 20 min readings. PAW levels were higher throughout the procedure in both the COPD and stenosis groups. In the obese patients, pCO2 was higher at both the 10 and 20 min recordings. CONCLUSION: HFJV provides effective ventilation for most patients undergoing MSL, even if they are obese or have COPD or laryngeal stenosis.

Adult↗
PubMed1996

[Obstructive apnea syndrome during sleep secondary to a pharyngeal lymphoma. Improvement with continuous pressure treatment of the upper airway].

Obstructive sleep apnea syndrome (OSAS) is characterized by multiple episodes of upper airway (UA) obstruction during sleep. Patients experience daytime hypersomnia, sluggishness and inability to concentrate; snoring at night is common. We report the case of a man with Hodgkin's lymphoma without full remission and with pharyngeal recidivism leading to OSAS. He experienced marked diurnal hypersomnia accompanied by behavior disorders. Examination revealed flow-volume OSAS, suggesting UA instability. Cervical computed tomography showed a prevertebral lymphomatous mass in the pharynx causing significant UA compression. UA size increased considerably after use of continuous positive airway pressure (CPAP), which normalized sleep and produced significant relief of symptoms. Later, after chemotherapy, OSAS resolved and the patient was able to abandon CPAP treatment.

Hodgkin Disease↗