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Biomedical subjects

A Fernández-Cruz

Publications and source records attributed to A Fernández-Cruz.

At least 19 recordsLinked to original sources
PubMed2004

Smoking cessation and weight gain.

Cigarette smoking is the single most important preventable cause of death and illness. Smoking cessation is associated with substantial health benefits. Weight gain is cited as a primary reason for not trying to quit smoking. There is a great variability in the amount of weight gain but younger ages, lower socio-economic status and heavier smoking are predictors of higher weight gain. Weight change after smoking cessation appears to be influenced by underlying genetic factors. Besides, weight gain after smoking cessation is largely because of increased body fat and some studies suggest that it mostly occurs in the subcutaneous region of the body. The mechanism of weight gain includes increased energy intake, decreased resting metabolic rate, decreased physical activity and increased lipoprotein lipase activity. Although there is convincing evidence for the association between smoking cessation and weight gain, the molecular mechanisms underlying this relationship are not well understood. This review summarizes current information of the effects of nicotine on peptides involved in feeding behaviour. Smoking was shown to impair glucose tolerance and insulin sensitivity and cross-sectional studies have demonstrated that smokers are insulin-resistant and hyperinsulinaemic, as compared with non-smokers. Smoking cessation seems to improve insulin sensitivity in spite of the weight gain. Nicotine replacement - in particular nicotine gum - appears to be effective in delaying post-cessation weight gain. In a group of women who failed to quit smoking because of weight gain, a dietary intervention (intermittent very-low-calorie diet) plus nicotine gum showed to both increase success rate in terms of smoking cessation and prevent weight gain. On the other hand, body weight gain at the end of treatment was significantly lower in the patients receiving bupropion or bupropion plus nicotine patch, compared with placebo. Studies with new drugs available for the treatment of obesity - sibutramine and orlistat - are warranted.

Body Composition↗
PubMed2002

[Short-term and long-term evolution of deep vein thrombosis treated by a health care unit].

INTRODUCTION AND OBJECTIVES: Deep vein thrombosis (DVT) is a common disease, with a high risk of complications persisting for years. Until recently, the treatment of this condition was on an hospitalary basis. Nevertheless, there is growing evidence suggesting an adequate management on an ambulatory basis with low molecular weight heparin (LMWH). Based upon these observations, and observational study was performed to determine short-term ad long-term complications of DVT treated by a Home Care Unit (HCU). METHODS: A total of 125 patients diagnosed of DVT by means of Doppler echography were treated on an ambulatory basis with subcutaneous nadroparine followed by oral anticoagulants (OAC) or LMWH alone, when a contraindication for acenocumarol use was present. The characteristics of the study population and their risk factors were studied, as well as the presence of bleeding or relapse during the acute period. Once the acute period with surveillance and treatment by the DHU was over, patients were followed at the Outpatient Clinics of the Internal Medicine Department. At each visit, the long-term complications were assessed: relapse, postflebitis syndrome (PFS), or death. RESULTS: The most common short-term complications were bleeding (3.2%) and relapse (7.3%). Eighteen percent of patients showed liver toxicity (increase of at least a 1.5 fold in the basal values of transaminases) secondary to the use of nadroparine. Nevertheless, this toxicity was mild in all cases and subsided when the medication was stopped. With a mean follow-up of 15.4 months, an overall 16.5% of patients relapsed, 25.8 % of patients had a PFS, and 23.7% of patients died. Death was associated with the presence of some risk factors (32.7% versus 7.69%; p = 0.004), and particularly when this risk factor was a tumor (75% versus 12%; p < 0.001). CONCLUSIONS: Deep vein thrombosis is a condition associated with common complications, both in the acute period and in the long-term. Nevertheless, it can be treated safely and efficiently by a HCU. This disease is associated with a high risk of mortality, particularly because it is usually associated with severe diseases.

Aged↗
PubMed2001

Localisation of endothelin-1 mRNA expression and immunoreactivity in the retina and optic nerve from human and porcine eye. Evidence for endothelin-1 expression in astrocytes.

We have investigated the localisation of endothelin-1 (ET-1) mRNA and ET-1-like immunoreactivity in retina and anterior portion of optic nerve from human and porcine eyes. In situ hybridisation method revealed expression of ET-1 mRNA mainly in the innermost layers of the retinas, in the retinal pigment epithelium cells as well as in the astrocytes of the optic nerve. Immunohistochemical studies showed that ET-1-like immunoreactivity appeared in the same regions where ET-1 mRNA was expressed as well as in the inner nuclear layer and in the inner segments of photoreceptors. In the nerve fibre and ganglion cell layers, astrocytes expressed both glial fibrillary acidic protein and ET-1 proteins suggesting that these cells may secrete ET-1. Expression of ETA and ETB receptors in human retina were demonstrated by reverse transcription-polymerase chain reaction. Our results demonstrated expression of ET-1 in glial, neural and vascular components of retina and optic nerve from human and porcine eyes.

Aged↗
PubMed2001

[Leukocytoclastic vasculitis associated with ticlopidine].

In the last five years the combination of ticlopidine plus aspirin has been the treatment of choice to avoid thrombi formation after the implantation of intracoronary stents. The adverse effects observed include the appearance of a maculopapulous, pruritic, painless, cutaneous rash. We present the case of a patient who developed leucocytoclastic vasculitis associated with the administration of ticlopidine.

Humans↗
PubMed2000

[Pattern of the distribution of total cholesterol and cHDL cholesterol Spanish children and adolescents: RICARDIN Study].

BACKGROUND: The RICARDIN Study multicenter study of cardiovascular risk factors in children and adolescents has described the standards of normality of blood cholesterol levels in the Spanish school population. The objective of the present study was to compare mean values of cholesterol between different regions of Spain, and to compare the global mean with a pool international study. Also, the pattern of total cholesterol and cHDL by age and sex using mathematical model is described, and comparison with two international studies carried out in USA and Japan is performed. SUBJECTS AND METHODS: 10,683 children aged 6 to 18 were selected from 7 different Spanish provinces (Madrid, Vizcaya, Lugo, Badajoz, Murcia, Asturias and Barcelona). Blood samples were obtained by capilar puncture (Reflotron). RESULTS: Mean values of total cholesterol was different among provinces, and globally, were lower than the international pooled population, although the pattern observed in each population was very similar. Total cholesterol curve for Spanish boys showed a curvilinear trend that can be estimated through a cubic function that explains 89% of observed data, while for girls the best estimate was obtained through an inverse function (R2 = 0.40). cHDL for boys showed a cubic function as the best estimate (R2 = 0.90), while for girls the best estimate was obtained through a quadratic function (R2 = 0.59). CONCLUSIONS: There are important physiological variations of total cholesterol level by age and sex in children and adolescents. The pattern of cholesterol does not follow a linear model but a curvilinear one, that need to be considered in clinically assessing individual determinations of cholesterol, since highest percentiles can vary by age and sex.

Adolescent↗
PubMed2000

Economic impact of HIV protease inhibitor therapy in the global use of health-care resources.

OBJECTIVE: To evaluate the clinical and economical impact of the introduction of HIV protease inhibitor (PI) therapy in the current clinical care of HIV-infected patients. METHODS: Cohort study with 155 HIV-infected patients with a full year of follow-up before and after the introduction of PI by June 1998. The setting was a large urban tertiary teaching hospital in Madrid, Spain. The main outcomes measures were clinical and immunological evolution, pharmacy, out-patient, emergency room and in-patient medical costs evaluated by diagnostic-related group classification, and the global economic costs of clinical care in HIV-infected patients (AIDS and non-AIDS). RESULTS: The cost of PI therapy was compensated fully by savings related to reduction of the number, length and severity of hospital admissions in AIDS cases. In contrast, more modest clinical effects with increased costs were observed in non-AIDS cases. Globally, there was an increase of about 20% in the total health-care costs of HIV-infected patients (P < 0.01). CONCLUSIONS: PI therapy is highly cost-effective in AIDS patients. Its value in less severely immunosuppressed patients requires further evaluation.

Adult↗
PubMed1999

Type B and type C natriuretic peptide receptors modulate intraocular pressure in the rabbit eye.

We investigated (1) the in vivo functional significance of the type B (ANP(B)) and type C (ANP(C)) natriuretic peptide receptors in the rabbit eye by evaluating the effect of intracameral administration of C-type natriuretic peptide (CNP) and C-ANP-(4-23) on intraocular pressure, and (2) the action of CNP on guanylate cyclase activity in the rabbit ciliary process membranes. Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) were also studied for comparison. We demonstrated that the natriuretic peptides decrease intraocular pressure and stimulate guanylate cyclase activity, CNP being the most potent. The duration of the effect of C-ANP-(4-23) on intraocular pressure reduction was almost 9-fold that of the BNP and 20-fold that of ANP and CNP effect. This ligand increased threefold the immunoreactive natriuretic peptides levels in aqueous humour. Our data demonstrate the presence of functional ANP(A) and ANP(B) receptors in the rabbit eye and that the ANP(C) receptor modulates the concentration of the natriuretic peptides in the aqueous humour.

Animals↗
PubMed1999

[The association of hematocrit with blood pressure and left ventricular mass in subjects over 55].

OBJECTIVE: To establish the association between hematocrit, blood pressure (BP), and left ventricular mass (LVM) in persons older than 55 years. PATIENTS AND METHODS: One hundred patients older than 55 years (46 males and 54 females) with a wide range in BP were studied on an ambulatory basis. The following parameters were determined: hematocrit, casual BP (CBP), 24-h ambulatory blood pressure monitoring (ABPM), left ventricular mass index (LVMI) determined by echocardiography (according to the Devereux's formula), cardiac output (CO) (determined by cardiac echocardiography), peripheral vascular resistances (PVR) (determined according to mean blood pressure and cardiac output), and levels of creatinine in plasma and sodium in 24-hour urine. RESULTS: Mean age of patients was 65 years (range 55 to 83 years). Twenty-two percent of patients were smokers (17 males and 5 females) with a mean of 13 +/- 6 cigarettes/day. Mean hematocrit value was 41.4 +/- 3.6% (43.3 +/- 3.5 for males and 39.7 +/- 2.7% for females) (p < 0.001). Thirty-five percent of males and 26% of females had mild-moderate hypertension with an hematocrit of 42.3 +/- 3.5% versus 40.8 +/- 3.6% (p < 0.05). The LVMI was 132 +/- 37 g/m2 (139 +/- 38 g/m2 for males and 127 +/- 36 g/m2 for females). A significant linear association was observed between hematocrit value and diastolic BP: casual (r = 0.25; p < 0.05, 24 h mean (r = 0.34; p < 0.001), mean from 7 to 23 hours (r = 0.32; p < 0.001), mean from 23 to 7 hours (r = 0.37; p < 0.001). For females, these relationships were: r = 0.41, 0.36; 0.34 and 0.41, respectively (p < 0.01). No significant association was observed between these parameters among males. Among hypertensive patients this association was observed 24-h mean diastolic BP and mean from 23 and 7 hours (r = 0.39; p < 0.05). Among normotensive patients the values for this association were: r = 0.25; p < 0.05 and r = 0.26; p < 0.05, respectively. No significant association was observed between hematocrit value and LVMI for the total group and for the established subgroups. CONCLUSIONS: Among patients older than 55 years a weak significant association was found between hematocrit value and diastolic BP (both casual and in that obtained with ambulatory monitoring), but not with the left ventricular mass. The mean hematocrit value was significantly higher for hypertensive than for normotensive patients.

Aged↗
PubMed1998

[Staphylococcus aureus bacteremia and a mass in the right atrium in a patient carrying a central port].

A male heroin abuser was admitted because of Candida endophthalmitis. A permanent central venous line was inserted. Three months later, he had positive catheter and blood cultures with Staphylococcus aureus. Transthoracic and transesophageal echocardiography and magnetic resonance revealed a right atrial mass. Treatment with antibiotics in addition to clinical and echocardiographic follow up was decided upon. Six weeks later, a transesophageal echocardiography showed a decrease in right atrial mass size and the patient was discharged asymptomatic without treatment. Three months later, he was well and a new transesophageal echocardiography showed a further decrease in atrial mass size with signs of fibrosis. This follow up supports the clinical suspicion of thrombus in the right atrium attributable to a central venous line and Staphylococcus aureus bacteremia.

Adult↗
PubMed1998

[All mortality by cause of death. The challenge of coronary prevention].

Much debate on the benefits and risks of cholesterol lowering to prevent coronary heart disease has focused on excess non-CHD mortality rates reported in some trials. Because of the wide variation in design of cholesterol-lowering trials and because the non-CHD mortality rate was not a controlled endpoint of statistical power in most published studies, it has been difficult to determine whether any excess mortality was due to certain therapies, to other mechanisms, or to chance. As a result, some investigators have performed retrospective analyses of pooled trial data in order to augment statistical power. Some investigators have hypothesized that the human brain is dependent on a constant supply of cholesterol from the circulation and that cholesterol loss in neuronal membranes, with the possible consequences of behavioral disorders and increased risk of accident and violent death. Indeed Weidner and Griffin suggest that low cholesterol is a marker for poor underlying health; physical illnesses are likely to cause depression and other negative emotional states, which are often accompanied by suppressed appetite and weight loss causing reduction in cholesterol levels. Such mental states may also increase the risk of non-CHD death, for example suicide. Rossouw reviews the evidence concerning non-CHD mortality in cholesterol-lowering trials and reports metaanalyses carried out for all trials combined. The findings indicated a significant (15%) increase in non-CHD mortality in all trials combined. However, this was not related to cholesterol lowering itself, because there was no increased risk in trials with > 10% cholesterol reduction, whereas there was a significant (22%) increase in trials with lesser degrees of cholesterol lowering. The publication of a large secondary prevention trial (4S) employing Simvastatin for cholesterol lowering supports the idea that cholesterol reduction itself does not have adverse effects on non-CHD mortality. The overview of all published trials demonstrates their effectiveness in reducing cholesterol and provides clear evidence of benefits on stroke and total mortality. A 10% reduction in cholesterol yielded about a 20% decrease in CHD mortality, which would be expected to result in about a 6% reduction in total mortality. Endothelium-dependent relaxations are reduced in hyperlipidemia and atherosclerosis. Exogenous L-arginine improves or restores the reduced endothelium-dependent relaxations. Moreover inflammation is associates with the initiation and progression of atherosclerosis. The fact of the matter is the Cardiovascular drugs already in clinical use or in development are able to interfere with certain aspects of endothelial function and may be useful in protecting the vessels and, hence, in preventing the development of cardiovascular disease.

Cause of Death↗
PubMed1997

[Association between blood pressure and circulating hormonal factors with left ventricular mass in patients with essential hypertension older than 55 years of age].

BACKGROUND: The prevalence of left ventricular hypertrophy (LVH) is higher in elderly patients with hypertension than in normotensive patients. The factors relationed herewith are not well known. The first purpose was to analyse the relationship between the levels of blood pressure (BP) recorded by ambulatory blood pressure monitoring (ABPM) and the left ventricular mass index (LVMI) in a group of untreated patients older than 55 years with essential hypertension. Our second purpose was to observe the relationship between the concentration of several circulating hormones and the left ventricular mass index. SUBJECTS AND METHODS: The study included 31 untreated patients with mild to moderate essential hypertension and 37 healthy normotensives. Both groups were of similar age, sex and body mass index. We determined for both groups the casual arterial pressure (CAP), ambulatory BP monitoring (ABPM) throughout 24 h, daytime (07.00-23.00 h), nighttime (23.00-07.00 h), left ventricular mass index (LVMI) (following Devereux's formula) and circulating levels of endothelin-1, aldosterone, renine, free adrenaline and noradrenaline. RESULTS: The ILVM in hypertensive patients was 139.6 +/- 35.9 g/m2 and in 124.0 +/- 31.8 g/m2 in normotensive (p < 0.05). The percentage of patients with LVH was 63 and 43%, respectively (p < 0.05). The LVMI in hypertensive patients was correlated with the diastolic CAP (97 +/- 7 mmHg) (r = 0.41; p < 0.05), unlike with the systolic CAP (164 +/- 18 mmHg). The ILVM in normotense patients was not associated neither with the systolic CAP (126 +/- 10 mmHg) nor with the diastolic (79 +/- 6 mmHg). In hypertensive patients we found a slight association between the LVMI and the systolic ABPM (130 +/- 14 mmHg) during nighttime (r = 0.41; p < 0.05). The rest of average ambulatory BP and the hormonal values at study did not show a correlation with the LVMI in both groups. CONCLUSIONS: A slight correlation exists between BP (casual and determined with ambulatory blood pressure monitoring throughout 24 hours) and the left ventricular mass index in mild to moderate untrated hypertensive patients older than 55 years. We did not observe correlations between the circulating levels of endothelin-1, renin, aldosterone, free adrenaline and noradrenaline and the left ventricular mass. The average ventricular mass and the number of subjects with ventricular hypertrophy was significantly increased in hypertensives than in normotensives.

Aged↗
PubMed1997

[Axillary-subclavian thrombosis: review of its etiology and features in recent years].

OBJECTIVES: To describe etiology and clinical characteristics of all patients diagnosed with axillary-subclavian vein thrombosis (ASVT) in our center. METHODS: Retrospective study during last 4 years (January 1991 to December 1994). Only those patients with a typical phlebography were included. RESULTS: 42 patients were diagnosed with ASVT. 10 in 1991, 6 in 1992, 10 in 1993 and 16 in 1994. The average age was 56.3 years. About sex, 20 were in men and 22 in women. The right upper extremity was affected in 16 patients, left side was in 24 and 2 were bilateral. Respect the incriminating agent, a central venous line was the most common, finding in 24 patients (57.14%). A local external compression was detected in 9 patients (21.4%), in 5 the ASVT was associated to a hypercoagulability state and finally only 2 patients were diagnosed with spontaneous o effort ASVT (4.76%). In those associated to a central catheter, 8 patients had a subclavian venous line and 6 had a drum catheter. Lung, colon and breast malignancies were the types of tumours more diagnosed. Treatment basically consisted on intravenous heparin, dicumarinics and subcutaneous heparin. Long term results are not valid because most patients haven't post-treatment phlebography. CONCLUSIONS: The possession of a catheter in the subclavian vein and the existence of a malignancy; especially a lung, colon or breast cancer, are the factors more associated with the development of an axillary-subclavian vein thrombosis in our area. The long of the average life span, the development and use of new oncologic treatment, besides the increasing use of the subclavian veins could do that ASVT would be a more frequent disease. In patients with several associated factors, could be used profilactics treatments.

Adult↗
PubMed1996

[Retroperitoneal hematoma after percutaneous transluminal coronary angioplasty].

An 80-years-old woman was admitted to our hospital because of unstable angina. The coronariography showed three-vessel coronary artery disease. The patient denied revascularization with coronary artery bypass surgery and coronary angioplasty (PTCA) was performed over two vessels with success. Within the following days, the patient began with pain suggesting femoral nerve compression and a decrease of the hematocrit without external bleeding. A computed tomography (CT) scan was performed to confirm the suspicion of retroperitoneal hematoma. This a rare complication of coronary angioplasty but it's important to remember because its increment during last years.

Aged↗
PubMed1994

[Effect of suppression of apnea on arterial pressure and plasma catecholamines in normotensive patients with sleep apnea].

BACKGROUND: The association of high blood pressure (HBP) and the sleep apnea syndrome (SPS) and the beneficial effect of SAS treatment on HBP are well known. The direct effect of the continuous nocturnal administration of positive air pressure (CPAP) on blood pressure is not, however, well known. The aim of this study was to evaluate the blood pressure (BP), plasma catecholamines (PC) and urinary derivatives of catecholamines (UDC) in 17 normotensive subjects (4 females; age 49 +/- 11 years) with SAS, prior to and after correction of apnea with CPAP. METHODS: Twenty-four hour outpatient registry of blood pressure (OPRBP) and after nocturnal polysomnography were performed both basal and during CPAP administration for two nights. Urine was collected over these 24 hour period for measurement of UDC. At 7 hours a blood sample was collected for measurement of PC. RESULTS: SAS was corrected by CPAP in all the patients with a reduction in mean BP (24 h: 87 +/- 6 vs 84 +/- 6 mmHg, p < 0.05, diurnal, 90 +/- 6 vs 87 +/- 6 mmHg, p < 0.05, nocturnal, 84 +/- 6 vs 82 +/- 7 mmHg, NS) and the percentage of diastolic BP > 90 mmHg (24 h: 10 +/- 7 mmHg vs 6.5 +/- 6 mmHg, p < 0.01, diurnal, 15 +/- 10 vs 10 +/- 10 mmHg, p < 0.05, nocturnal 5.2 vs 5 vs 3 +/- 4 mmHg, p < 0.05). The plasma catecholamines tended to reduce, although not significantly, without changes of urinary metabolites. CONCLUSIONS: There is a significant decrease in blood pressure with the administration of continuous positive air pressure even in normotensive patients. An early correction of sleep apnea syndrome may reduce the high prevalence of hypertension associated with this syndrome.

Adult↗
PubMed1994

Persistent choroidopathy in systemic lupus erythematosus.

We report a case of a rare entity, choroidopathy in association with systemic lupus erythematosus (SLE), previously described in only twelve patients to our knowledge. It manifested by multiple focal serous elevations of the sensory retina and/or serous detachments of the retinal pigment epithelium bilaterally. No retinal vascular changes were observed. The probable pathogenesis is related to choroidal vascular disease due to systemic hypertension secondary to lupus nephritis, vasculitis, or a combination of these.

Choroid Diseases↗