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Biomedical subjects

C Alfaro

Publications and source records attributed to C Alfaro.

17 recordsLinked to original sources
PubMed2006

Conversion from calcineurin inhibitors to everolimus in kidney transplant recipients with malignant neoplasia.

Cancer has been reported to be more common among kidney transplant recipients than waiting-list patients or the general population. Use of anticalcineurin agents and azathioprine are relevant risk factors. Nine renal allograft recipients (seven men and two women) of mean age 67.6 (55-77) years and mean time after transplantation of 30.7 (58-216) months were switched to everolimus-based immunosuppression because of the presence of biopsy-proven malignancies (eight patients) or neurological tacrolimus toxicity (one patient). One patient with posttransplant lymphoproliferative disease also received chemotherapy with a good evolution at 6 months. He showed an initial increase in the protein to creatinine ratio (peak 3.3 mg/mg at 3 months) that was controlled by increasing the enalapril dose. One patient with skin cancer and severe atheromatosis (baseline SCr 2.5 mg/dL, creatinine clearance 17 mL/min, and protein to creatinine ratio 3.2 mg/mg), had cyclosporine and everolimus overlapped for 25 days, showing a continued poor evolution requiring dialysis initiation at 3 months after switch. The other six patients with recurrent skin cancers had good cancer evolution, with no new skin tumors and regression of skin lesions in three, including not biopsied actinic keratosis. Sudden switching from calcineurin inhibitors to everolimus is safe and may be used in long-term transplant recipients with malignancies. In patients with advanced chronic nephropathy this approach appeared to be less beneficial.

Aged↗
PubMed2003

Genetic relationships among Orobanche species as revealed by RAPD analysis.

RAPD markers were used to study variation among 20 taxa in the genus OROBANCHE: O. alba, O. amethystea, O. arenaria, O. ballotae, O. cernua, O. clausonis, O. cumana, O. crenata, O. densiflora, O. foetida, O. foetida var. broteri, O. gracilis, O. haenseleri, O. hederae, O. latisquama, O. mutelii, O. nana, O. ramosa, O. rapum-genistae and O. santolinae. A total of 202 amplification products generated with five arbitrary RAPD primers was obtained and species-specific markers were identified. The estimated Jaccard's differences between the species varied between 0 and 0.864. The pattern of interspecific variation obtained is in general agreement with previous taxonomic studies based on morphology, and the partition into two different sections (Trionychon and Orobanche) is generally clear. However, the position in the dendrogram of O. clausonis did not fit this classification since it clustered with members of section TRIONYCHON: Within this section, O. arenaria was relatively isolated from the other members of the section: O. mutelii, O. nana and O. ramosa. Within section Orobanche, all O. ramosa populations showed a similar amplification pattern, whereas differences among O. crenata populations growing on different hosts were found. Orobanche foetida and O. densiflora clustered together, supporting the morphological and cytological similarities and the host preferences of these species.

Genetic Markers↗
PubMed2000

[Cryptosporidium spp. in farms in the eastern region of Venezuela].

Cryptosporidiosis is caused by the coccidian protozoa Cryptosporidium. It is the most worldwide prevalent pathogen associated with diarrhea in young cattle and usually is caused by C. parvum which is also responsible of infections in humans, specially in immunocompromised patients. Faecal samples from 75 young cattle aged between 2 to 20 weeks, were collected in four Western Dairy farms of Venezuela and screened for the presence of Cryptosporidium oocysts. Positive samples were detected in 22 animals (29.3%). Results of this current study demonstrate that Cryptosporidium spp. is frequently involved in the aetiology of calf neonatal diarrhea in this region, and adults carriers seem to play an important role as a source of infection.

Age Factors↗
PubMed1998

[Social problems encountered during prenatal care in a Paris maternity ward].

In 1993, about 2,600 children are born in Robert Debré Hospital (RDH), a hospital specialized in pediatrics and obstetrics located in Paris. One hundred and seventy nine of the mothers contacted the hospital social service during pregnancy. The main goal of this study was to describe the social problems encountered by these women and the solutions proposed by the social service of RDH. The second aim was to describe the socio-demographic profile and medical problems of this population. At first contact, 45% of the women had no social coverage, and only 18% had a steady job. Most social problems were related to administrative procedures. Financial and housing problems were more difficult to solve in this context. These figures reflect the growing problem of precarity, with its consequences. A hospital social service is not the right place to solve these very complex problems. The most worrisome point is that the living conditions of newborn children are often unknown after delivery.

Adult↗
PubMed1994

Large experimental segmental bone defects treated by bone transportation with monolateral external distractors.

Monolateral frames were applied to five dogs and ten lambs for treatment of large segmental bone defects (LSBD) surgically induced in one of their femoral diaphyses. Reconstruction was attempted by bone transport, as developed by Ilizarov. Monolateral frames were used to minimize the draw-backs of Ilizarov's circular device. Radiographic, computed tomographic, and histologic studies were performed. The skin and soft tissues were not a major obstacle for the longitudinal migration of the screws during bone transport. Four months after the operations, healing and remodeling of the bone defect was always satisfactory. Histologically, the repair of the lengthened segment followed an intramembranous ossification pattern in its central areas and in the periphery as well. At the end of the experiment, the new induced bone had a virtually normal diaphyseal bone appearance. Bone transport for the treatment of experimental LSBD can be completed in monolateral frames.

Animals↗
PubMed1993

[Evaluation of the screening strategy for lead poisoning in 1-to-3-year-old children monitored in maternal-child welfare centers in Paris].

A procedure for screening for lead poisoning was implemented since 1987 in the maternal and child health centers of 6 Paris "arrondissements". It relies on a screening of the children through environmental and clinical information. Our study aimed at evaluating this procedure and at estimating the prevalence of lead poisoning in the children aged 1 to 3 years old attending free maternal and child health centers in Paris. We did a cross-sectional survey of a sample of 512 children. A questionnaire concerning each child's risk factors was answered by the paediatric nurses of the clinics. Potential lead poisoning cases were detected by capillary determining of free erythrocyte protoporphyrins (FEP). Blood lead level (PbB) was measured in children with FEP > or = 350 micrograms/l. The prevalence rate of lead poisoning was estimated at 1.9% +/- 1.7% for a PbB threshold > or = 250 micrograms/l and at 9.6% +/- 3.5% for a PbB threshold > or = 150 micrograms/l. The detection procedure identified 4 children out of 5 with a PbB > or = 250 micrograms/l and 2 children out of 3 with a PbB > or = 150 micrograms/l.

Child, Preschool↗
PubMed1993

[Analysis of emergency recruitment in a pediatric hospital. Effect on the organization of available care].

BACKGROUND: The increasing demand on the emergency wards of pediatric hospitals raise the question of whether the services delivered are adequate for the explicit and implicit needs of outpatients. POPULATION AND METHODS: The files of all the 334 children consulting at the medical emergency ward of Robert-Debré hospital in Paris between April 19 and April 26, 1989 were analyzed. Socio-demographic data, reasons for visit and final diagnosis were collected. Each outpatient was assigned to one of 3 categories: 1) severe emergency; 2) simple emergency; 3) consultation. Further data on the events leading to the visit were obtained by a second survey covering 213 children seen between May 11 and May 14, 1991 from 8 hrs to 20 hrs. RESULTS: The mean age of the 334 children in the first survey was 3.2 years. Half of the mothers were unemployed. Half of the families was of foreign extraction. 3.4% of the children had no social insurance. Ten percent of the patients were frequent users of the emergency ward. Infectious diseases were the most prevalent reason for visit. Severe emergencies were 28%, simple emergencies 44% and consultations 28%. Among the 213 children of the second survey, half of the families had seen (43%) or attempted to see (7%) a physician outside the hospital before coming to the emergency ward. CONCLUSION: The needs of the children could best be met by performing a true medico-social examination at the medical emergency ward, enhancing access for children and revitalizing a partnership with the community to provide continuous care for those children in need of it.

Child, Preschool↗
PubMed1992

[Causes and modalities of pediatric ambulatory care in ten hospitals in the Ile-de-France region].

BACKGROUND: The increasing shortage of financial resources requires optimal use of hospital care by patients. However, the studies carried out to date in France have been limited to patients who are hospitalized, and have not included those seen as out-patients. POPULATION AND METHODS: All patients seen as out-patients in 10 hospitals in the Paris district (3 pediatric hospitals and 7 pediatric departments located in hospitals for adults and children), during the week of 19-26 April 1989, were given a questionnaire on the age, sex, nationality, socio-cultural and economic features of the family, history of earlier medical visits or admissions, the existence of pediatrician or practitioner, and the means and time taken to get to the hospital. Medical diagnosis was established for each patient following the WHO International Classification of Diseases (9th edition). RESULTS: 2,365 out of 2,675 questionnaires were usable. The main features were: 50% of patients were less than 3 years old, 55% were of French origin; 78% belonged to families with relatively low socio-economic status. Both parents had professional activities in 49% of families, 7% of mothers did not speak or write French. The ratio of patients aged less than 3 years admitted to the emergency ward was higher than the average. The most frequent diseases presented by these patients were respiratory (23%), infectious (14%), gastro-intestinal (10%) and neurological (7%); 14% of the patients were seen for symptoms that could not be assigned to a specific disease. 39% of patients were seen in out-patient clinics and 61% in emergency wards. 40% were sent by a health professional to out-patient clinics and only 25% to emergency wards. CONCLUSIONS: Despite the fact that this study is subject to particular conditions, i.e., relative frequency of infectious diseases due to seasonal causes, it suggests that the hospital is becoming the primary source of health care with an increasing percentage of patients seen in "emergency", even though this emergency is often more apparent than real. Health care networks should be established.

Ambulatory Care↗
PubMed1989

Inverse correlation of expiratory lung flows and sputum eosinophils in status asthmaticus.

Seventy-six consecutive patients admitted to Los Angeles County General Hospital with acute asthma were studied. Blood and sputum smears for cell counts were obtained on all patients within 12 hours of admission. Fifty-one (67%) patients were able or willing to perform spirometry and flow/volume curves in the first 24 hours of hospitalization. The severity of airway obstruction as assessed by forced expiratory volume in one second (FEV1), maximum mid-expiratory flow rate (MMFR), and forced vital capacity (FVC) was compared with blood and sputum eosinophil counts. Although there was no relation between the blood eosinophilia and airway obstruction, an inverse relationship between the number of eosinophils in the sputum and airway flow rates was observed. Higher percentages of sputum eosinophils were associated with diminished flow rates. We believe that sputum eosinophils may be helpful in the initial assessment of severe bronchial asthma.

Adolescent↗
PubMed1986

Blood helper/suppressor lymphocyte ratio in sarcoidosis.

The blood helper/suppressor ratio was measured in 38 patients with biopsy-proved sarcoidosis. There was no relationship between this peripheral helper/suppressor ratio and the activity of the granulomatous process. This test needs further evaluation before its routine use in assessing activity in sarcoidosis.

Antibodies, Monoclonal↗
PubMed1986

Hypercalciuria and renal stones in a sarcoidosis patient treated by extracorporeal shockwave lithotripsy.

A case of chronic pulmonary sarcoidosis and hypercalciuria complicated by bilateral renal stones is reported. Urinary stones were pulverized by extracorporeal shockwave lithotripsy (ESWL) as the patient had declined any surgical procedure. The use of ESWL in conjunction with corticosteroids appears to be the treatment of choice in the management of renal stones secondary to abnormalities of calcium metabolism in sarcoidosis.

Adult↗
PubMedDate not supplied

[The immunotherapy potential of agonistic anti-CD137 (4-1BB) monoclonal antibodies for malignancies and chronic viral diseases].

Pharmacological intervention on the immune system to achieve more intense lymphocyte responses has potential application in tumour immunology and in the treatment of chronic viral diseases. Immunostimulating monoclonal antibodies are defined as a new family of drugs that augment cellular immune responses. They interact as artificial ligands with functional proteins of the immune system, either activating or inhibiting their functions. There are humanized monoclonal antibodies directed to the inhibitory receptor CD152 (CTLA-4) that are being tested in clinical trials with evidence of antitumoural activity. As a drawback, anti-CTLA-4 monoclonal antibodies induce severe autoimmunity reactions in a fraction of the patients. Anti-CD137 monoclonal antibodies have the ability to induce potent immune responses mainly mediated by cytotoxic lymphocytes with the result of frequent complete tumour eradications in mice. Comparative studies in experimental models indicate that the antitumour activity of anti-CD137 monoclonal antibodies is superior to that of anti-CD152. CD137 (4-1BB) is a leukocyte differentiation antigen selectively expressed on the surface of activated T and NK lymphocytes, as well as on dendritic cells. Monoclonal antibodies acting as artificial stimulatory ligands of this receptor (anti-CD137 agonist antibodies) enhance cellular antitumoural and antiviral immunity in a variety of mouse models. Paradoxically, anti-CD137 monoclonal antibodies are therapeutic or preventive in the course of model autoimmune diseases in mice. In light of these experimental results, a number of research groups have humanized antibodies against human CD137 and early clinical trials are about to start.

Animals↗
PubMedDate not supplied

Are intravenous corticosteroids required in status asthmaticus?

Seventy-seven patients with status asthmaticus were prospectively studied to compare oral with intravenous methylprednisolone. Patients were given methylprednisolone, either 160 or 320 mg orally or 500 or 1000 mg intravenously, daily in equally divided doses. They were randomly assigned to either group on a daily sequential basis. Spirometry was performed within one hour of the initial dose of steroids. The mean presenting forced expiratory volume in 1 s was 26% of the predicted value. Spirometry was then repeated every six hours for the first 24 hours and then every eight to 12 hours until discharge or 72 hours, whichever occurred first. There were no significant differences in the incidence of respiratory failure, forced expiratory volume in 1 s, days of hospitalization, rate of improvement in pulmonary function, or side effects. No patient who went into respiratory failure did so more than three hours after receiving the initial dose of steroids. We conclude that oral methylprednisolone is safe and effective in the treatment of status asthmaticus.

Administration, Oral↗