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Biomedical subjects

A Carmona

Publications and source records attributed to A Carmona.

At least 19 recordsLinked to original sources
PubMed2004

[Evaluation of a pharmaceutical care program to improve adherence to antiretroviral therapy].

OBJECTIVE: To establish the impact of a pharmaceutical care program on the improvement of adherence to antiretroviral therapy, and on patient immunologic and virologic outcome. MATERIALS AND METHODS: A multicenter, observational, prospective study in a HIV-infected patient cohort under treatment with antiretrovirals selected by random sampling in 19 Spanish hospitals. The study lasted 12 months, in which the program was applied through a baseline preprocedural visit and 4 quarterly visits. Adherence estimation was based on pill counting. An adherence > or = 90, or > or = 95% was considered adequate (in two time points). RESULTS: 541 patients were included, most of them were males (68.8%) between 20 and 78 years of age. Major risk groups included injecting drug users (43.4%) and heterosexuals (29.4%). Sixty percent had already received treatment for more than 3 years. Mean baseline viral load and CD4 count values were 32,866 copies/ml and 485 cells/mm3, respectively. Throughout the study a slight increase in the percentage of adherent patients was seen; however, statistical significance was not reached (64.3 and 79.2% of patients showed an adherence > 95 and > 90%, respectively, during the fourth quarter, versus 59.8 and 75.5% at baseline). A statistically significant decrease in viral load and increase in CD4 cells was seen following program application. The percentage of patients with a viral load < 200 copies/ml was 72.2, 76.7, and 75.0% at the 2nd, 3rd, and 4th quarters, respectively, versus 64.2% at baseline. CD4 cell counts increased by 50 cells/mm3 on average from the start to the end of follow-up. CONCLUSIONS: Patients included in the program had a good immunologic and virologic outcome, and a trend towards an increased percentage of patients with good adherence was also seen. These results confirm the need to implement follow-up programs for patients receiving antiretrovirals in order to ensure maximum therapeutic benefits.

Adult↗
PubMed2001

Virologic outcome and predictors of virologic failure of highly active antiretroviral therapy containing protease inhibitors.

In this observational single-center cohort study outside the clinical trial setting, outcome and predictors of virologic failure of highly active antiretroviral therapy (HAART) containing a protease inhibitor were evaluated in human immunodeficiency (HIV)-infected persons. The study population consisted of 807 protease inhibitor-naive HIV-seropositive patients who initiated antiretroviral therapy with reverse transcriptase inhibitors and protease inhibitors (indinavir, nelfinavir, ritonavir) between January 1997 and January 1999. Demographic variable, plasma HIV-1 RNA levels, CD4+ T-cell count, adverse drug reactions, and adherence to HAART were assessed. Virologic treatment response was defined as a decrease in plasma HIV-1 RNA load from baseline to below 500 copies per milliliter after 12 months of therapy. Levels of HIV-1 RNA were undetectable in 43% of patients at 12 months. Factors associated with failure to suppress viral load included age 40 years or younger, baseline CD4+ T cell count less than 200 x 10(6) per liter baseline viral load greater than 4.3 log(10) per milliliter, and non-adherence to HAART. After adjustment by logistic regression, non-adherence was the only statistically significant variable associated with virologic failure (odds ratio 0.38, 95% confidence interval 0.21 to 0.67). Unselected patients in whom protease inhibitor is started in a usual clinical setting achieve viral suppression less frequently than do patients in controlled clinical trials. Failure to adherence to HAART was the strongest predictor of virologic failure.

Adult↗
PubMed2000

Quality indicators in ambulatory surgery. A prospective study.

Introduction: Ambulatory Surgery has emerged and developed in Spain in a similar way as in other occidental countries. Once established as a model for surgical care, results must be improved using objective quality indicators to assure minimal morbidity, efficient use of resources and satisfaction of patients and family. Objective: To provide a list of quality assessment indicators in Ambulatory Surgery and to discuss the necessity of obtaining a general consensus regarding the complexity of both the operations and the patients undergoing surgery. Design: Prospective and descriptive study. Patients and Methods: The study was performed on 833 ambulatory patients operated on in the Ambulatory Surgical Unit of the Can Misses Hospital of Ibiza. Surgical specialities involved were General Surgery, Ophthalmology, Orthopaedics, Urology, Gynaecology, and E.N.T. All diagnoses and proceedings were classified according to the CIE-9 and DGR systems, showing as an example the codes related to the General Surgery department. Quality Indicators evaluated were: (a) unplanned admission index; (b) re-admission index; (c) emergency department consultations; (d) cancellation index; (e) substitution index; and (f) postoperative pain evaluation. Results: Specialities involved were: Ophthalmology 277 patients (33.2%), General Surgery 189 (22.8%), Orthopaedics 142 (17%), Urology 90 (10.8%), E.N.T. 79 (9.5%) and Gynaecology 56 (6.7%). Unplanned Admission Index was 7.2%; Re-Admission Index 0.4%; Emergency department consultation 1.6%; Cancellation Index 3.3% and Substitution Index 70%. The reasons for unplanned admission were due to specific complications in 36 cases (60.1%), followed by those secondary to an inadequate selection of the patient in 22 cases (36.6%). Conclusions: It is necessary to apply a series of Quality Indicators in Ambulatory Surgery. Their systematic evaluation may help us define national standards in order to continuously improve our results.

Journal Article↗
PubMed2000

Anatomical variations in the human paranasal sinus region studied by CT.

A precise knowledge of the anatomy of the paranasal sinuses is essential for the clinician. Conventional radiology does not permit a detailed study of the nasal cavity and paranasal sinuses, and has now largely been replaced by computerised tomographic (CT) imaging. This gives an applied anatomical view of the region and the anatomical variants that are very often found. The detection of these variants to prevent potential hazards is essential for the use of current of endoscopic surgery on the sinuses. In the present work, we have studied the anatomical variants observed in the nasal fossae and paranasal sinuses in 110 Spanish subjects, using CT in the coronal plane, complemented by horizontal views. We have concentrated on the variants of the nasal septum, middle nasal concha, ethmoid unciform process and ethmoid bulla, together with others of lesser frequency. The population studied showed great anatomical variability, and a high percentage (67%) presented one or more anatomical variants. Discounting agger nasi air cells and asymmetry of both cavities of the sphenoidal sinus, which were present in all our cases, the variations most often observed were, in order, deviation of the nasal septum, the presence of a concha bullosa, bony spurs of the nasal septum and Onodi air cells.

Adult↗
PubMed2000

[The recommendations of GESIDA/SEFH/PNS for improving adherence to antiretroviral treatment. AIDS Study Group of the Spanish Society of Hospital Pharmacy and the National Plan on AIDS of the Minister of Health and Consumers].

The main objective of HAART is to achieve a complete suppression of the viral replication for long time. However, when the therapeutic drug levels are low, HIV can replicate and it can develop resistances. This fact can be the reason of treatment failure, HIV transmission of resistant strains and therefore an inappropriate use of the economical resources. In order to get the adequate therapeutic drug levels it is necessary to have a good adherence to the treatment. We review the factors that influence the adherence, the evaluation methods and we recommend the possible intervention strategies which should be given by a multidisciplinary team, integrated by physicians, pharmacists, nurses, psychologists and other personal support. To start HAART is not an emergency. For this reason is very important to prepare to the patient and to identify the non-adherence factors in order to correct it. Once the HAART is indicated it is very important to offer information during the medical prescription and when the drugs are dispensed. During the therapy is necessary to follow actively all patients on HAART. In order to make therapeutical decisions we need to know the patient drug adherence rate. We recommend to use several methods to calculate the drug adherence rate, being the most commonly used the patient interview, the patient questionnaire, the refill count, the pharmacy visits rate together with the viral load evolution of the patient. In order to get all this information it is necessary to have a very good communication between all the people involved in HIV infected patients care. If non-adherence is detected it is necessary to start the intervention strategies to correct it and if they fail it might be necessary in some cases to stop HAART. The potential benefits of the adherence programs can justify the economical spend in human and hospital facilities resources.

Anti-HIV Agents↗
PubMed1999

Monitoring of antimicrobial therapy by an integrated computer program.

OBJECTIVE: To assess the impact of the setting-up of a computer program designed by the Hospital Pharmacy Department as a tool that provides information for the antimicrobial therapy monitoring. To assess its influence on pharmaceutical costs. MATERIAL AND METHOD: The computer application for the follow-up of antimicrobial treatments integrates information from the Pharmacy Department and the Microbiology Laboratory and selects all patients to whom some controlled antibiotic has been prescribed. The pharmacist reviews all the controlled antibiotic treatments, suggests any change to the physician if needed and quantifies the economic impact of the accepted interventions. RESULTS: On average, 12.5% of controlled antibiotic treatments warranted a pharmaceutical intervention, and 92% of them were accepted. The most frequent interventions related to prescriptions were change of dosage and administration route and related to the disease were in respiratory and urinary tract infections. From the economic point of view, the accepted interventions represented a saving of 12,087,029 pesetas (83,359 $)/year, on average. CONCLUSION: The applied computer program resulted a useful tool for a clinical pharmacist to reach more correct antibiotical therapeutics and better cost-effectiveness relation. It also helped to achieve favorable clinical outcomes.

Anti-Bacterial Agents↗
PubMed1999

[Adherence to very active antiretroviral treatment: impact of individualized assessment].

BACKGROUND: To determine if the intervention of individual advice improves adherence and effectiveness to highly active antiretroviral therapy. METHODS: Randomized open trial. Patients treated with zidovudine + lamivudine + indinavir were assigned (2/1) to conventional care or individual advise. Individual advise consists in adaptation to treatment to patient style of live and detailed information of therapy. Adherence were estimated with structured interview and pillo counts and were considered correct when more than 90% of prescribed drugs were taken. RESULTS: Patients 170, conventional care: 110 and IA: 60. FOLLOW-UP: 24 weeks. Baseline characteristics were similar in both groups. Correct adherence were estimated in 52.7% of conventional care and in 76.7% of individual advise (p = 0.002, relative risk: 1.45; CI 95%: 1.16-1.82). Undetectable viral load (NASBA < 50 copies/ml) in 54.5% of conventional care and in 65% of individual advise (p = 0.18, relative risk: 1.19; CI 95%: 0.93-1.53). Reduction of viral load in the conventional care group 1.02 +/- 0.5 log10/ml, and in the individual advise group 1.98 +/- 0.7 log10/ml. CONCLUSION: The individual advice improve adherence with a tendency to improve effectiveness of highly active antiretroviral therapy.

Adult↗
PubMed1999

[Drugs, inhibitors and other stories. From cancer chemotherapy to nutritional toxicology].

The designation as speaker of the XVIII Annual Conference "Karl Gaede", sponsored by the Asociación Venezolana de Bioquímica y Biología Molecular, provided me with the opportunity to revisit the path constructed in twenty five years of biochemical research. This path stretches from cancer chemotherapy to nutritional toxicology, following the elusive thread that interconnects the metabolic network buried in the ground of any biological process. This work summarizes experiences derived from the use of drugs, inhibitors and stimulators that act on specific enzymatic steps. As a metabolic artisan, I have used these tools to unveil the peculiarities and the inherent character that give continuity to the conductive thread across the whole biological universe.

6-Aminonicotinamide↗
PubMed1998

Determination of tetracycline and its major degradation products by liquid chromatography with fluorescence detection.

A liquid chromatographic method of tetracycline and its major degradation products on a C8-reversed phase column with acidic mobile phase and fluorescence detection is described. The quantification limit, measured as the amount of sample that gave a signal ten times the peak-to-peak noise of the baseline, was: 0.25 ng for tetracycline (TC) and epitetracycline (ETC), 25 ng for and 4-epianhydrotetracycline (EATC) and 50 ng for anhydrotetracycline (ATC) of injected standard. By means of this liquid chromatography (LC) assay TC, ETC, EATC and ATC as main degradation products of tetracycline, can be separated and determined with good sensitivity and specificity within 15 min.

Anti-Bacterial Agents↗
PubMed1997

Histological changes during development of the cerebellum in the chick embryo exposed to a static magnetic field.

Few studies have been performed to evaluate the ultrastructural changes that exposure to static magnetic fields (SMF) can cause to the processes of cell migration and differentiation in the cerebellum during development. Thus, we have studied the development of the cerebellum in the chick embryo (n = 144) under a uniform SMF (20 mT). All of our observations were done on folium VIc of Larsell's classification. The cerebella of chick embryos, which were exposed solely on day 6 of incubation and sacrificed at day 13 of incubation [short exposure (S)1; n = 24], showed an external granular layer (EGL) that was less dense than the EGL in the control group (n = 24). The molecular layer (ML) exhibited a low number of migratory neuroblastic elements. Moreover, the internal granular layer (IGL) was immature, with the cellular elements less abundant and more dispersed than in controls. In chick embryos exposed on day 6 of incubation and sacrificed at day 17 (S2; n = 24), the outstanding feature was the regeneration of the different layers of the cerebellar cortex. The cerebellar cortex of chick embryos exposed continuously to an identical field from the beginning of the incubation up to day 13 [long exposure (L)1; n = 24] or day 17 (L2; n = 24) of incubation showed a higher number of alterations than that of group S1. Electron microscopy confirmed the findings from light microscopy and, at the same time, showed clear signs of cell degeneration and delay in the process of neuronal differentiation. This was more apparent in groups L1 (100%) and L2 (100%) than in groups S1 (95.4%) and S2 (65.2%). In conclusion, the present study showed that SMF can induce irreversible developmental effects on the processes of cell migration and differentiation of the chick cerebellar cortex.

Animals↗
PubMed1996

Skeletal maturation of wrist and hand ossification centers in normal Spanish boys and girls: a study using the Greulich-Pyle method.

The skeletal maturation of the upper limb distal segment was studied in 239 Spanish boys and girls between birth and 14 years of age. The atlas of Greulich and Pyle, offering standards of skeletal development of white North American children, was used as reference. The results obtained show firstly that in absolute terms, the ossification process is earlier in girls than in boys. This difference is maximum between 5 and 11 years of age. The boys show a delay of around 3 months with respect to their North American opposites. The girls, in contrast, show a better fit to the corresponding (female) standard of the atlas. In general, the highest agreement between bone age and chronologic age is for the ossification centers of the distal epiphysis of the ulna and radius and for those of the metacarpal bones. At the level of the carpus, individual analysis of the ossification centers shows that the capitate and hamate bones in the girls evolve most in accord with chronologic age. At the other extreme, and in both sexes, the ossification centers of the trapezium and trapezoid bones are statistically furthest from chronologic age.

Adolescent↗
PubMed1996

[Spontaneous rupture of renal angiomyolipoma].

OBJECTIVES: An additional case of spontaneous rupture of renal angiomyolipoma is described. METHODS: The images and clinical data of the present case are presented. RESULTS: A comparative analysis of the appropriate treatment described in the literature was performed. CONCLUSIONS: If possible, conservative surgery should be attempted.

Angiomyolipoma↗
PubMed1996

Tannins: thermostable pigments which complex dietary proteins and inhibit digestive enzymes.

The presence of antinutritional factors in legume seeds and other vegetables has been considered as an expression of the chemical warfare of plants against their predators. As a consequence, the nutritional utilization of these foods has only been possible through the use of a variety of treatments (cooking, fermentation, germination) which increase nutrient bioavailability. Nonetheless, some factors are not destroyed by effect of seed processing, among which stand a family of polymeric polyphenols called tannins. These pigments have the ability to complex and precipitate proteins and inhibit digestive enzymes. This paper describes what has been accomplished in regards to the selection of an appropriate solvent to extract bean polyphenols, the assessment of the most commonly used assay procedures, the purification of bean tannins and the evaluation of their interaction with proteins and digestive enzymes, responsible for their antinutritional effect.

Dietary Proteins↗
PubMed1996

[Aggressive behavior of the male volcano mouse Neotomodon alstoni (Rodentia: Cricetidae)].

A study was carried out on the agonistic behavior of the male volcano mouse, Neotomodon alstoni, with 50 pairs of males which were classified as possible dominants (D) and subordinates (S), utilizing Melzack-Thompson's Method. The aggressiveness levels exhibited by this mouse were recording in the combinations: D vs. D and S vs. S. Two groups were formed: Group I with 12 pairs of D males and 13 of S males, and Group II with 11 pairs of D males and 14 of S males. In Group I the aggressiveness level was quantified after one week of mating and after another week of isolation, and in Group II the sequence of observation was inverted. The aggressiveness level was measured by the number of attacks per hour, an attack being defined as the aggressive physical contac of an animal (aggressor) with another (attacked). The kinds of behavior registered, including offense, defense, and submission patterns, revealed hierarchic relationships. Dominance was correlated significatively (p < 0.05) with a higher level of aggressiveness.

Agonistic Behavior↗
PubMed1995

Microsurgical anatomy of the human ophthalmic artery: a mesoscopic study of its origin, course and collateral branches.

In the present paper we have studied the gross (mesoscopic) anatomy of the ophthalmic a. in humans, using magnification by microsurgical systems to obtain data on the origin and course of this artery and its main collateral branches. Comparison of our results with previous reports indicates that, although the anatomical variations of the vascular system are well known, some patterns of frequency may be emphasised. Thus, the ophthalmic a. was usually found as a collateral branch of the internal carotid a., although other origins were also found. The ophthalmic a., once inside the orbit, followed a course above the optic nerve in most cases. All the collateral branches of the ophthalmic a., with the exception of the muscular branches, showed great constancy.

Adult↗