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Biomedical subjects

A Rodríguez

Publications and source records attributed to A Rodríguez.

At least 361 records · Page 20Linked to original sources
PubMedDate not supplied

Confronting and eradicating an epidemic of bacteraemia.

Obtaining vascular access by catheterisation is a good option, especially in patients with vascular system fragility. In the authors' department, there was an increase in Gram Negative Bacillus (GNB) infection in patients with long term catheters (LTC). An objective was set to design an action plan and a new working methodology in order to eradicate the infection and the cause. Three periods were established in the prospective follow-up of LTC patients: the pre-epidemic period (01/94 to 03/99), with a bacteraemia every 144 days per patient, the epidemic period (04/99 to 12/00) with a bacteraemia every ten days per patient, and the post-epidemic period (01/01 to 04/02). A multidisciplinary working group was established, which produced action plans for nursing and technical staff. The working methodology of the service was studied and analysed by means of a review. The deionised water cultures at the entrance to the haemodialysis ward were negative. The dialysis and connector cultures were positive for GNB, confirming that they were of the same genetic origin. An evaluation of the periods was carried out, studying the working methodology, to which no changes were made between the pre-epidemic and epidemic period. In the post-epidemic period, a number of changes were made to the care dynamic, with no other bacteraemia arising to date. Adapting and improving protocols is a good indicator of quality. The role of nursing staff is vital in prevention of GNB.

Bacteremia↗
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[Malabsorption syndrome due to Strongyloides stercoralis associated with Loeffler syndrome in a 29-year-old woman].

We report a case of chronic infection by Strongyloides stercoralis in a 29-year-old Colombian woman who had been living in Spain for 2 years. The patient had recurrent abdominal pain and malabsorption syndrome. The diagnosis was made through intestinal biopsy in upper gastrointestinal endoscopy. Transport of the parasite through the lung parenchyma (Loeffler syndrome) was visible on simple chest X-ray. Bronchoalveolar lavage, bronchoalveolar aspirate and repeated stool examination were negative.

Adult↗
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Membranoproliferative glomerulonephritis associated with a mixed-cell germinal ovary tumor.

We describe a patient with membranoproliferative glomerulopathy associated with a mixed-cell germinal ovary tumor (embryonal and dysgerminoma components). Advanced renal failure ensued without remission of nephrotic syndrome after surgery. Five other cases of ovary tumor associated with glomerulopathy and reported in the literature are reviewed. The association between membranoproliferative glomerulonephritis and mixed-cell germinal ovary tumor has not been previously reported.

Adolescent↗
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The subtalar joint: embryology and morphology.

Several different aspects of the subtalar joint are studied. Embryology indicates that it is a recently acquired structure. The anterior subtalar joint does not have a uniform morphology, and it has been subdivided into three anatomical descriptions (ovoid, bean, and two part). To correct the confusion found in other papers, we intend to clearly describe the anatomy of the ligaments. The form and function of the retinacula, cervical ligament, and ligament of the canal are studied. The microscopic anatomy of ligaments is studied, dealing specifically with their innervation and the structure of their fibers.

Ankle Joint↗
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Spontaneous separation in idiopathic vitreomacular traction syndrome associated with contralateral full-thickness macular hole.

PURPOSE: Vitreomacular traction syndrome (VMTS) and full-thickness macular hole are two different well-known entities that on follow-up may be subjected to clinical modifications. Precisely, a spontaneous separation of idiopathic VMTS occurred in three eyes of three patients relieving in addition traction of the posterior hyaloid that had led also to a focal macular retinal pigment epithelial detachment (RPE). An association to a full-thickness macular hole was observed in the contralateral eye of one of the patients. METHODS: This is a retrospective study of three patients evaluated with fluorescein angiography and documented with optical coherence tomography using the Stratus (OCT) model 3000, with scans analysis and protocols analysis, measuring the size and shape of vitreomacular adhesions, macular thickness changes before and after the spontaneous separation of the tractional posterior hyaloid adhesion. In addition, the vitreous was evaluated with contact lens slit lamp biomicroscopy and ultrasound. The associated contralateral macular hole in one of the patients was surgically treated. RESULTS: Two of the three eyes with spontaneous separation of the VMTS recovered 20/25 central visual acuity; the other eye maintained the initial 20/50 visual acuity. The treated macular hole recovered 20/100 corrected visual acuity. CONCLUSIONS: Spontaneous separation of posterior hyaloid is a possible outcome during follow-up of idiopathic VMTS that can be well evaluated and documented with OCT while macular fluorescein angiography may be silent in cases like these presently reported. Central vision recovery can be excellent following the spontaneous separation, which releases anterior-posterior traction including on the retinal pigment epithelium and decreases macular thickness as measured with OCT. Therefore, regarding management, the indication for vitrectomy should be delayed awaiting the spontaneous release of vitreomacular traction in 4 to 6 months. The association between idiopathic VMTS in one eye and full-thickness macular hole in the opposite eye of one patient is an important pathophysiologic consideration.

Aged↗
PubMedDate not supplied

[Santiago, a terror-stricken city].

The general purpose of this article is to determine how citizens' fear of lack of safety affects the use of public spaces. In an evaluation such as this, it is necessary to analyze two types of relationships pertaining to violence: the one between victimization and a perception of being unsafe, and the one that exists between social attitudes and the peaceful resolution of national conflicts. To this end, an analysis was performed of different variables--victimization, feeling unsafe, use of physical spaces, attitudes toward the established political and social institutions and toward the resolution of national conflicts--and of potential associations between these variables. The data for the study came from a survey of 1,200 persons between 18 and 70 years old who were residents of Santiago. Results show that Santiago's citizens live in fear and that their perception of a lack of safety has grown more intense, despite the fact that victimization rates remained relatively stable over the years preceding the survey. Fear is associated with an abandonment of both physical and sociopolitical public spaces, as well as with seeking refuge in private spaces and private life. There is a widespread attitude in favor of resolving conflicts through non-peaceful means, and such an attitude is more often associated with feeling unsafe, having negative attitudes toward democracy, and lacking hope in the nation's future. The results of this study support the notion that, in order to overcome their fear, people tend to adapt to reality by adopting a conformist attitude, taking on standard beliefs and behaviors, and overestimating the use of force as a way of resolving their differences.

Adolescent↗
PubMedDate not supplied

[Antimicrobial drug use in the department of internal medicine of a general hospital: prevalence study].

OBJECTIVE: To ascertain the general pattern of hospital antimicrobial use, costs, and adequacy of treatment in the department of internal medicine of a general hospital. MATERIAL AND METHODS: A prevalence study was carried out and all department beds were visited. Every patient who was being treated with antimicrobials during or 24 hours prior to the visit was selected for the study. Treatment was considered adequate when indication, selected drug, dosage, and treatment duration were all adequate. When considering costs, only the price of the antimicrobials was evaluated. RESULTS: We identify 173 hospitalized patients, 79 (45.6%) of them were treated with 96 antimicrobial agents. The prevalence of community-acquired and hospital-acquired infections was 39.3% and 8.1%, respectively. Empirical use amounted to 77%. Overall, b-lactams antibiotics were the most frequently used (63.5%). In 22 (27.8%) patients treatment was judged inadequate, the most frequent error being an excessive duration (17.8%). The daily spending on antimicrobials was 187,750 ptas., representing 1,085 ptas. per hospitalized patient and day. CONCLUSIONS: A high percentage of hospitalized patients receive treatment with antimicrobial drugs. Because of the low rate of antimicrobials with a specific indication, the long antibiotic course duration, the incorrect drug choice, and even more the antimicrobial prescription in non-infected patients, strategies to improve the quality of antimicrobial use are clearly required

English Abstract↗
PubMedDate not supplied

[Risperidone in the treatment of psychotic, affective and behavioral symptoms associated to Alzheimer's disease].

INTRODUCTION: A total of 235 patients with diagnoses of Alzheimer's dementia together with psychotic and/or affective symptomatology, as well as behavioral disturbances was included in an open label postmarketing surveillance study. The study objectives were to asses: 1) risperidone efficiency in psychotic and affective symptomatology and behavioral disturbances; 2) risperidone influence in the patient's performance, 3) dosage range at which efficiency is observed; and 4) safety in this group of patients. Patients were observed during a six month period. Risperidone was used at a mean dosage of 1.23 +/- 0.86 mg daily (range: 0.5-4.5 mg daily). MATERIAL AND METHODS: Risperidone was assessed by the Clinical Global Impression (CGI), Geriatric Depression Scale (GDS), Neuropsychiatric Inventory (NPI), Clinical Deterioration Rating (CDR), UKU subscale for neurological side effects and spontaneous reports. Patients were evaluated at baseline, 15 days and months 1, 2, 4 and 6. Sixteen patients (6.8%) were excluded from the statistical analysis due to protocol violation. Fifty four patients (24.7%) dropped out. RESULTS: Risperidone produced a significant improvement in the mean total scores of CGI, NPI, GDS (patient's satisfaction, hope.) and CDR (judgment and problem solving, community affairs, hobbies.) scales. Extrapyramidal symptoms improved from day 15 onwards in patients who had received antipsychotic treatment previously; in naive treated patients these symptoms did not change during the study period. CONCLUSIONS: Risperidone was well tolerated. Only 6 (2. 7%) discontinued treatment due to adverse events. Ninety seven percent of the patients did not suffer any adverse event; the resting 2.7% suffered one or more side effects: sedation (1.4%), constipation (0.5%) and vomiting (0.5%) among others.

Alzheimer Disease↗
PubMedDate not supplied

[Fluoxetine (FX) efficacy in the treatment of cocaine dependence methadone maintenance patients. Interaction with plasma levels].

OBJECTIVES: The objective of this study was to assess the efficacy of fluoxetine (FX) treatment in cocaine dependent methadone (MTD) maintenance patients, to assess decrease or interruption of cocaine use and pharmacokinetic interaction between fluoxetine an methadone plasma levels. MATERIAL AND METHODS: The sample was composed of 11 patients with DSM IV criteria for opioid and cocaine dependence. We added Fluoxetine (20 mg per day) during 9 weeks in Majadahonda Drug Program. All patients were in methadone program a mean of 7.5 months. We made a psychiatry interview and the baseline severity of the mood disorder was assessed with the Clinical Global Impression ICG for therapeutic improvement. Cocaine use and fluoxetine treatment was measured in urine analysis and pharmacokinetic interaction between FX-MTD were measured with plasma levels of methadone. RESULTS: Fluoxetine was well tolerated combined with methadone. FX-MTD interaction didn't occur, resulting in no increased of MTD plasma level to dose before and after fluoxetine treatment. After fluoxetine treatment decreased cocaine use, changed cocaine tract from injected to smoked and improvement depressive symptoms.

Adult↗
PubMedDate not supplied

Nursing protocol for manipulation of haemodialysis catheters.

This study looked at the incidence of infection complications, in relation to central vein catheterisation as a provisional HD access, by means of the establishment of a nursing protocol for the handling of these catheters. Central vein catheterisation is a classical technique in Nephrology.

Adult↗
PubMedDate not supplied

[False negatives in the diagnosis of myasthenia gravis].

INTRODUCTION: Myasthenia gravis is an uncommon disorder with very variable clinical findings. This often leads to errors in diagnosis. OBJECTIVE: To study the main errors leading to false negatives in the diagnosis of myasthenia gravis. PATIENTS AND METHODS: We carried out a questionnaire to determine all the doctors and diagnoses made by them in relation to symptoms of myasthenia graves in 109 patients in whom this diagnosis was later confirmed when a specialist was consulted. RESULTS: Most of the patients went to a general practitioner first. During this initial consultation the disease was only diagnosed in 10 cases (9.2%) and neurosis was the most frequent diagnosis (27.5%). Although most patients had to see from two to four doctors before diagnosis was made, there was no major delay in this. In 84 of the 109 cases the diagnosis was established within the first six months, generally by a neurologist (86.2%) and less frequently by a general physician (11.0%). CONCLUSION: General practitioners, ophthalmologists, psychiatrists and otorhinolaryngologists are often involved in the evaluation of these cases although they made little contribution to the diagnosis.

Adult↗
PubMedDate not supplied

[Renal osteodystrophy in Spain. Multicenter survey. (I). Collaborative Centers of the Multicenter Study on Renal Osteodystrophy].

In order to know the current management of renal osteodystrophy in Spain we collected data from 172 centres (10,724 patients) obtained from a 30 questions enquiry designed to show different aspects of the current management of renal osteodystrophy. The levels considered the "goal" for treatment were: Calcium 10-10.5 mg/dL (53% of centres), 9.5-10 mg/dL (28%), 10.5-11 mg/dL (14%) and 9-9.5 mg/dL (5% of centres). Phosphorus: between 4.5 and 5.5 mg/dL (77% of centres), between 5.5 and 6.5 mg/dL (15%) and less than 4.5 mg/dL (8% of centres). Parathormone (PTH): between 120 and 250 pg/mL (75% of centres), between 60 and 120 pg/mL (19% of centres). The calcium concentration used in the dialysis fluids was 2.5 in 44% of centres, 3 in 28%, 3.5 in 26% and 2 mEq/L in the remaining 2% of centres. Pulse therapy was started with PTH higher than 750 in 16% of centres; with PTH higher than 500 pg/mL in 52% and with PTH higher than 250 pg/mL in 28% of the centres. Only 51% of centres decreased the calcium concentration in dialysis fluids when the patients were receiving parenteral calcitriol. Fifty-nine percent of centres considered a positive response to treatment any reduction in PTH levels, 24% of centres considered response a decrease of at least 20%, 78% of centres maintained the treatment with calcitriol 6 months before deciding if the patient was a "responder" or a "non-responder". Parathyroidectomy was performed when PTH was higher than 1,000 pg/mL in 38% of the centres; in 41% when PTH was between 1,000 and 750; in 19% when PTH was between 750 and 500; and when PTH was between 500 and 250 pg/mL in the remaining 2% of the centres. Five percent of the patients had a parathyroidectomy.

Chronic Kidney Disease-Mineral and Bone Disorder↗
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[Bone metabolic markers and use of vitamin D in dialysis. Multicenter survey. (II). Collaborative Centers of the Multicenter Study on Renal Osteodystrophy].

Renal osteodystrophy has become one of the most important aspects related with morbidity in dialysis patients. The aim of our study was to analyse the main biochemical markers of mineral metabolism in 7,422 dialysis patients from 147 Spanish centres. We present data about serum Ca, P, Ca-P, product, Al and vitamin D. Due to the distribution of the analytical results (not normal), non-parametric tests were used. In this analysis a p < 0.01 was considered as significant. The mean total levels were: Ca 9.7 +/- 0.9 mg/dL; P 5.6 +/- 1.6 mg/dL; Ca-P product 54 +/- 16 mg/dL; PTH 294 +/- 360 pg/mL and Al 27 +/- 23 micrograms/L. There was a great variation particularly on serum Ca and PTH levels. On the contrary, serum P and Ca-P product values were less spread: only a quarter of the patients had P levels higher then 6.5 mg/dL and one third Ca-P product higher than 60. Fifty percent of patients had Al levels lower than 20 micrograms/L. Forty one percent of patients (2,811 out of the 7,422) had a PTH equal or lower than 120 pg/mL and 23% have PTH equal or lower than 60 pg/mL. Patients with PTH equal or lower than 60 have serum Ca levels significantly higher than the remaining patients, on the contrary, serum P, Ca-P product and Al levels were significantly lower. In this group, 21% of patients were receiving vitamin D (in spite of low PTH). On the contrary 32% of patients were not receiving calcitriol (despite PTH higher than 250 pg/mL). Forty four percent of patients were receiving vitamin D (46% on haemodialysis and 31% on peritoneal dialysis). Patients on haemodialysis showed serum Ca, P, PTH and Al levels higher than patients on peritoneal dialysis.

Biomarkers↗
PubMedDate not supplied

[Actual status of multiple sclerosis in Cuba. National cooperative group for the clinical trial "Recombinant interferon alpha-2b in multiple sclerosis"].

INTRODUCTION: Multiple sclerosis (MS) has been considered to be an uncommon disorder in Cuba. In recent years many Cuban investigators have worked hard studying MS in Cuba. DEVELOPMENT: We review the history, epidemiology, clinical characteristics, complementary investigations and clinical trials of recent studies published in national and international journals on the most important investigations done on MS in Cuba. There is an outstanding placebo-controlled, double blind, multicentric randomised clinical trial using recombinant alpha 2b-IFN in the relapsing-remitting clinical form in which the results obtained in the first 30 patients who completed 2 years treatment show a statistically significant reduction in the frequency of relapses and the number of patients free of relapses in patients who received alpha-IFN as compared with those given placebo treatment. CONCLUSIONS: There has been an increase in the number of studies made on MS in Cuba in the past two years. Numerous clinical, neuroepidemiological, neurophysiological, biochemical, immunological, imaging and neuropsychological investigations and clinical trials indicate a marked increase in understanding of MS. The results of all these studies indicated the need for the creation of a National Reference Centre for Patients with Multiple Sclerosis, due to the complexity of this type of patients and the need to offer improved medical attention from a specialist team and to integrate the investigations in Cuba and internationally so as to reach the level of more developed countries.

Adjuvants, Immunologic↗
PubMedDate not supplied

Tolerance of immunotherapy with a standardized extract of Alternaria tenuis in patients with rhinitis and bronchial asthma.

We studied the safety of immunotherapy with an Alternaria extract in patients with rhinitis and bronchial asthma. The few studies that have investigated immunotherapy with mold allergens suggest that they cause adverse reactions more frequently than do other extracts. All treatments prescribed by our allergology service with Alternaria immunotherapy between 1988 and 1996 were recorded and analyzed. In all cases a biologically standardized depot extract of Alternaria tenuis containing 5 BU/ml was used according to a conventional immunotherapy schedule. During the study period 129 patients received immunotherapy with Alternaria extract. Of the 3,892 doses given, 1.95% led to adverse reactions, which occurred in 39.5% of the patients. Most of the adverse reactions were systemic and mild, and reproduced the underlying disease. The risk of adverse reactions was significantly higher in children, patients with asthma, and during the initial phase of treatment. Patients who suffered from adverse reactions had a significantly higher level of total and specific IgE. It was concluded that tolerance of Alternaria mold extract was worse than for other allergenic extracts, although most reactions recorded were mild. The risk of adverse reactions was greater in children and patients with asthma, and during the initial phase of immunotherapy.

Adolescent↗
PubMedDate not supplied

[Effectiveness and safety of topiramate in treatment-resistant bipolar disorder].

INTRODUCTION: This study was conducted to evaluate the effectiveness and safety of topiramate as add-on therapy for treatment-resistant bipolar disorder. METHODS: Twenty-one DSM-IV bipolar patients, considered resistant to treatment with lithium, carbamazepine or valproate, gave informed consent to receive increasing doses of the novel anticonvulsant topiramate as adjunctive therapy for their manic (n= 9), depressive (n= 6), hypomanic (n= 3), mixed (n= 2) or schizoaffective manic (n= 1) symptoms. The dosage of other mood stabilizer drugs remained unchanged throughout the 6-week follow-up. Outcome measures included the YMRS, HDRS-17, and CGI scales. Fifteen out of 21 patients completed the 6-week follow-up. RESULTS: Six patients (40% of completers, 29% by intention-to-treat) were considered responders to topiramate (> 50% reduction in YMRS or HDRS-17 and a decrease of 2 points in CGI). The drug was less effective in intially depressed patients. Topiramate was well tolerated and only one patient discontinued due to side-effects. The most common adverse effect was paresthesia (n= 2). Ten patients experienced moderate weight loss during the follow-up. The mean topiramate dose at endpoint was 158 mg/day. CONCLUSIONS: These preliminary results suggest that topiramate may be a useful therapy for bipolar disorders, with promising results even in the most treatment-refractory patients.

Adult↗
PubMedDate not supplied

[Assessment of long-term bone metabolism in patients with relative hypoparathyroidism after changing the calcium concentration of the dialyzate to 3mEq/L].

The existence of a low-bone turnover, non-aluminium related, has been more prevalent in recent years. Factors involved include the increasing number of older and diabetic patients initiating dialysis. Also higher intake of calcium salts and the widespread use of vitamin D derivates may play a role. Demonstration of low PTH secretion allows the recognition of the group of patients with special risk of adynamic bone disease. Little can be done to improve bone remodelling apart from correct management of risk factors previously mentioned. A decrease in dialysate calcium concentration can act in this way, but the long term effect of this procedure on bone mineral density has scarcely been established. The aim of this study was to evaluate the long term effect of lowering the dialysate calcium concentration from 3.5 to 3 mEq/L on bone mass and PTH activity in patients with hypoparathyroidism. We studied 19 patients with PTH < 120 pg/ml and calcemia between 8.5 and 10.5 mg/dl, without aluminium intoxication. Blood levels of Ca, P, alkaline phosphatase, aluminium, iPTH and dialysis doses were measured every 4 months during the two years of follow-up. Phosphate binders were closely monitored. Also calcium dietary feeding was measured by a 5-day dietetic registry at the beginning and 6 and 12 months later. Bone mineral density was assessed by quantitative computed tomography of the distal radius initially and after 18 months. PTH values had significantly increased from the first measurement (from 46 +/- 33 to 97 +/- 68 four months later). At the end of follow up, 8 patients (42%) had reached the objective of maintaining a PTHi above 120 pg/ml, while 11 had not reached it (3 were previously parathyroidectomized and two were diabetic). Only one patient has developed an exaggerated PTH response that has been controlled with oral vitamin D. No bone mineral loss was observed during the follow up. In conclusion, the use of a 3 mEq/l dialysate calcium may improve hypoparathyroidism in a substantial number of patients, avoiding the untoward effect that lower calcium concentration has on bone mineralization.

Aged↗