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Biomedical subjects

A Arrazola

Publications and source records attributed to A Arrazola.

14 recordsLinked to original sources
PubMed2000

An evidence-based programme for smoking cessation: effectiveness in routine general practice.

BACKGROUND: Smoking cessation clinical practice guidelines are based on randomised clinical trials reporting outcomes in persons who participate in these studies. However, many practitioners are sceptical about the effectiveness of these recommendations when applied to the general population in everyday routine consultation. AIM: To evaluate the results of a comprehensive smoking cessation programme in routine primary care practice. METHOD: All smokers consulting in 10 general practices during one year participated in a non-randomised controlled trial. The percentages of subjects in the intervention (n = 1203, seven practices) and control (n = 565, three practices) groups who reported sustained abstinence between six and 12 months follow-up and were validated biochemically were compared. The effect of the programme was adjusted to baseline differences in both groups by multiple logistic regression analyses. RESULTS: The programme resulted in an increase of five percentage points (95% CI = 3.1%-6.8%) in the validated and sustained one-year abstinence probability, with 7.1% for all of the intervention practices (adjusted OR = 3.7, 95% CI = 2.4-5.7). CONCLUSION: Programmes that combine advice to stop smoking to all smokers attending general practices with the offering of support, follow-up, and nicotine patches to those willing to stop are feasible and effective in routine practice, as primary care clinicians need only identify 20 smokers to get one additional success attributable to the programme.

Administration, Cutaneous↗
PubMed1993

Cell volume regulation in rat thymocytes.

1. DIOA (dihydroindenyl-oxy-alkanoic acid), a potent inhibitor of the K(+)-Cl- co-transport system, fully blocked regulatory volume decrease (RVD) in swelled rat thymocytes, with an IC50 of 2.2 +/- 0.5 x 10(-5) mol l-1 (mean +/- S.D., n = 4). Conversely, RVD was resistant to quinine, quinidine, apamin, cetiedil, amiloride, bumetanide and DIDS (4,4'-diisothiocyanostilbene-2,2'-disulphonate). 2. DIOA-sensitive RVD followed mono-exponential kinetics, with t1/2 (half-lifetime) of 1-3 min and maximal capacity (Cmax) of about 55% of the initial cell swelling. Cmax and the initial rate of RVD (Vo) were both linear functions of the increase in cell volume. 3. RVD was: (i) slightly increased by replacing external Cl- by NO3-, (ii) reversed by replacing external Na+ by K+ (in the presence of external Cl-) and (iii) inhibited by cell K+ depletion. All these phenomena were blocked by DIOA (86 mumol l-1). 4. Increased membrane potassium permeability by valinomycin was unable to accelerate RVD or RVD reversal. 5. In the presence of DIOA, thymocytes responded like osmometers (the relative cell volume was a linear function of the reciprocal of the relative osmolality) in a large range of osmolalities. 6. The results strongly suggest that RVD in rat thymocytes is mediated by the K(+)-Cl- co-transport system.

Animals↗
PubMed1992

The stilbene disulfonic acid DIDS stimulates the production of TNF-alpha in human lymphocytes.

Exposure of human peripheral blood mononuclear cells (PBMC) to the stilbene derivative DIDS (4,4'-diisothiocyanatostilbene-2,2'-disulfonic acid) (60 microM and above) significantly increased the release of tumor necrosis factor-alpha (TNF-alpha), as determined by TNF-alpha activity in the incubation media. When the TNF-alpha message was analyzed in PBMC by a reverse transcription/polymerase chain reaction (RT/PCR)-based procedure, it was found that incubation with DIDS (60 microM) was followed by a time-dependent accumulation of TNF-alpha mRNA. Measurements of intracellular pH showed that the presence of increasing concentrations of DIDS resulted in a progressive intracellular alkalinization of PBMC. It is suggested that the known DIDS effect of inhibiting transmembrane anion exchange, i.e., chloride/bicarbonate exchange, might play a role in the stimulation of TNF-alpha production by PBMC exposed to DIDS.

4,4'-Diisothiocyanostilbene-2,2'-Disulfonic Acid↗
PubMed1991

Enhanced renal PGE2 in hypertensives with increased red cell Na(+)-Li+ countertransport.

In this study, maximal velocities of Na(+)-Li+ countertransport were measured in red blood cells of 50 untreated essential hypertensives and 30 normotensive controls. In addition, urinary excretion of renal prostaglandins (PG) and plasma renin activity (PRA) was measured in each subject. Maximal velocity of Na(+)-Li+ countertransport was above the upper limit in controls of 525 mumol.l cell-1.h-1 in seven patients and was normal in the remaining patients. Patients with increased countertransport did not differ significantly from controls and from patients with normal countertransport with regard to urinary excretion of 6-keto-PGF1 alpha (the stable metabolite of prostacyclin) and thromboxane B2 (TxB2) (the stable metabolite of thromboxane A2). In contrast, mean values of PGE2 were significantly higher (P less than 0.01) in patients with increased countertransport (411 +/- 39 pg/min) compared with patients with normal countertransport (181 +/- 15 pg/min) and controls (146 +/- 13 pg/min). In addition, six patients with increased countertransport exhibited urinary levels of PGE2 higher than the upper limit in controls. Hypertensives with increased countertransport showed enhanced PRA when compared with the remaining patients (2.96 +/- 0.50 vs. 1.30 +/- 0.52 ng.ml-1.h-1, P less than 0.05) and with controls (1.86 +/- 0.08 ng.ml-1.h-1, P less than 0.05). Finally, the relationship between PGE2 and PRA was found to be significant in patients with increased countertransport (r = 0.776, P less than 0.05). These results indicate that renal synthesis of PGE2 is enhanced in essential hypertensives with increased Na(+)-Li+ countertransport activity and hyperreninemia.

Adult↗
PubMed1991

Is the erythrocyte sodium-lithium countertransport a molecular marker of cardiac risk in hypertension?

Current research is being directed toward the identification of markers of cardiac risk in hypertension, according to demographic, clinical, genetic, challenge-response and laboratory predictors. Much interest has centered around cationic transporters as laboratory markers, not only because they might make good predictors of cardiac risk, but also because of their potential for explaining the pathophysiology of that disorder. To date, there is no cationic transporter that clearly discriminates between subjects with low and with high cardiac risk, although the sodium-lithium (Na(+)-Li+) countertransport in red blood cells has come the closest. High rates of Na(+)-Li+ countertransport have been found to be associated not just with essential hypertension but more specifically with subgroups of patients suffering from essential hypertension who have a higher frequency of severe hypertension and increased risk of cardiac disease. Here, we examine different lines of clinical evidence suggesting that increased Na(+)-Li+ countertransport activity may identify patients with essential hypertension who are at an increased risk of cardiac disease because they also present other cardiac risk factors, namely hyperlipidemia and/or left ventricular hypertrophy. In addition, the pathophysiological basis for the association of hypertension and the above cardiac risk factors with increased Na(+)-Li+ countertransport are discussed.

Antiporters↗
PubMed1989

Is there increased cardiovascular risk in essential hypertensive patients with abnormal kinetics of red blood cell sodium-lithium countertransport?

Na+ transport kinetics were studied in red blood cells (RBCs) from 50 essential hypertensive patients and 30 normotensive controls. Seven hypertensive patients were characterized by the following: (1) a maximal rate of Na+-Li+ countertransport higher than an upper normal limit of 525 mumol.litre cells-1.h-1; (2) an apparent dissociation constant for internal Na+ higher than an upper normal limit of 20.4 mmol.litre cells (in only five of the seven hypertensives); (3) no other kinetic abnormality in Na+,K+ pump, Na+,K+ cotransport or passive Na+ permeability. Clinically, hypertensives with abnormal countertransport were characterized by high serum low-density lipoprotein (LDL) cholesterol levels and the presence of electrocardiographic left ventricular hypertrophy (LVH). Conversely, mean values of these two clinical parameters were normal in the remaining hypertensive patients, independently of the presence of other abnormalities in Na+,K+ pump, Na+,K+ cotransport or passive Na+ permeability. In conclusion, the presence of abnormal Na+-Li+ countertransport kinetics in erythrocytes may be associated with an enhanced cardiovascular risk in hypertension.

Adolescent↗
PubMed1987

[Stimulation of the hydrolytic activity of Na+,K+-ATPase in the erythrocytes by arginine vasopressin].

The effects of arginine vasopressin (AVP) on Na+,K+-ATPase activity in human erythrocytes have been studied. AVP stimulates enzymatic activity with no effect on transport activity. Since the enzymatic reaction with AVP can proceed in the absence of ion transport, it may explain the discrepancies between the in vivo and in vitro effects observed with the hormone on Na+ processing by the kidney.

Arginine Vasopressin↗
PubMedDate not supplied

[Can we help our patients to stop smoking?: the experience of the Smoking Cessation Program].

OBJECTIVE: To describe the process and results of the Smoking Cessation Program in order to answer this question: Does the lack of time and resources justify poor involvement of physicians in helping patients to stop smoking? METHODS: Prospective series of cases that included all smokers (n = 1203) who for any reason attended seven general practices over a period of one year. The behaviour of smokers when the program was offered as well as the workload generated by the implementation of the process are described. Subjects who stopped smoking were those who did not smoke two years after enrolment in a sustained and validated form for least 12 months. RESULTS: A total of 7.3% of all smokers quit (95% confidence interval [CI]: 5.9-8.9). Enrolment of subjects caused an increase in the consultation time of 23 seconds and decreased from a mean of 30 new smokers per month per practice during the first three months to 12 at the end of the first year. All received advise to stop smoking (mean increase of 3 min and 33 s) but only 17.5% accepted the therapeutic plan during the first year (95% CI: 15.4-19.9) that had a duration of 72:11 min and generated a mean of six programmed appointments a month in each practice. Twenty percent of subjects who participated in the therapeutic plan stopped smoking (95% CI: 14.8-26.1). CONCLUSIONS: Identification and universal advice to smokers, together with treatment of those who are motivated to quit, achieved important success rates without increasing excessively ordinary work loads.

Adult↗
PubMedDate not supplied

[Population-based epidemiology of colorectal cancer: causality review].

The estimated number of new cases of colorectal cancer per year in Spain (no. 19,166) is higher than other tumour locations. 1.56 times more cases of colon cancer are registered than of the rectum, and there are 1.44 times more cases in men than in women. Incidence and mortality are lower than the average for European countries; in historical series (1973-1999) an increase can be observed by age, period and birth cohorts between 1898 and 1932. On the contrary, in the USA a reduction of mortality can be observed from 1973 to 1999 (-20.8%) and of incidence from 1985 to 1999 (-7.4%). In Spain, the average duration of the disease in years is 4.29, lower than that of the European Community (4.57), and 72% of the figure for the most favourable country (5.93). Relative survival after five years in Spain is lower than in the USA (61.9% vs. 54%). Several dietary, environmental and lifestyle factors appear to be associated with colorectal cancer, but the risk or protection of these factors are of little weight and the results of studies are at times contradictory. The reduction of incidence in the USA indicates that intervention is possible to bring about a change of trend, predictably by means of secondary prevention.

Colorectal Neoplasms↗
PubMedDate not supplied

[Hospital care of cerebrovascular accident and the state of patients 12 months after].

OBJECTIVES: Cerebrovascular accident should be of key importance due to its magnitude in terms of mortality and disability. In this study we describe hospital care of patients and follow them one year after. The aims is to uncover areas of improvement in the care of patients. PATIENTS AND METHODS: Observational study of a randomized sample of 535 patient with a diagnosis of cerebrovascular disease, during de acute phase and 12 months after, using clinical records and telephone interview. RESULTS: Thirty five percent of patients arrived within 6 hours of the occurrence of the event. Thirty six percent had a CAT/MNR within 6 hours. Mortality at hospital was 13.8% increasing up to 26% at 12 months. At discharge 49% had a neurological deficiency. At 12 months 35.8% of the survivors interviewed showed a Barthel Index of less than 95 points. CONCLUSIONS: Organizational measures that guarantee a quick and systematic assessment of brain lesions, early diagnosis and active therapeutic offer, have to be implemented. In the sample studied, only 3% of the patient were candidates to thrombolytic therapy. Rehabilitation can and should play a more relevant role in the prevention of sequelae.

Acute Disease↗
PubMedDate not supplied

[The cost of cerebrovascular accident].

INTRODUCTION AND AIM: One out of three persons will die of cerebrovascular accident (CVA), another one will be disabled, and the third one will recover. This research has been taken to estimate the costs of CVA in the Basque Country. MATERIALS AND METHODS: The cost of illness is studied from a societal perspective. It is based on the prevalence of the disease. Population costs has been estimated from the use of resources of a randomized sample of patients admitted to hospital with stroke during the year 2000, and followed for 12 months. Transitions costs (those that happen just once) and state costs (those remaining in patients lifetime) have been studied separately. RESULTS: The prevalence of CVA was 1.780 x 10(5). Average transition cost per patient was 4,762 euros and average state cost for patient/year was 10,506 euros. The estimated cost for the Basque Country is 120,249,986 euros in the year 2000. Transition costs were 16,460,729 euros and state costs 103,789,257 euros in the same year. State costs were due to disability. CONCLUSIONS: The analysis of the costs of CVA from a societal perspective gets us to the heart of illness causing disability, the social costs of CVA are 74.3% of the total cost.

Adult↗