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Biomedical subjects

C García

Publications and source records attributed to C García.

At least 271 records · Page 15Linked to original sources
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[Wallenberg's syndrome secondary to dissection of the vertebral artery caused by chiropractic manipulation].

INTRODUCTION: Chiropractic manipulations of the cervical region are techniques that are used more and more frequently to treat a number of osteomuscular pathologies, but can give rise to important complications, such as the dissection of the cervical arteries. Dissection of the vertebral artery generally presents as alternating syndromes, of which Wallenberg s syndrome, either complete or incomplete, is the most frequent. In this paper we review the literature published to date on the pathogenesis, risk factors, clinical features, chronopathology, diagnosis, treatment and prognosis of this complication. CASE REPORT: We describe the case of a young patient who suffered from incomplete Wallenberg s syndrome a few hours after a single session of cervical chiropractic manipulation, and we also show the resonance images that were used to support the diagnosis. CONCLUSIONS: The appearance of a pain in the neck and neurological symptoms in a patient who has undergone chiropractic manipulation in the last few hours or days must lead us to consider a possible dissection of the cervical arteries. Dissection of the vertebral artery usually gives rise to alternating syndromes, the most frequent of which is lateral bulbomedullary infarction or Wallenberg s syndrome due to proximal occlusion of the posteroinferior cerebellar artery. Magnetic resonance angiography of the supra aortic trunks and cranial magnetic resonance scanning are valid techniques for demonstrating the dissection of the artery and the associated ischemic lesion.

Adult↗
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[Equality in medical education policy in Mexico].

We compared the results of the educational policies of public versus private medical schools and traditional versus module-based medical programs. The comparison centers on the political value of equality. The hypotheses are the following: a) Public and module-based schools offer more equality of opportunities for enrollment, permanence and graduation of students than private and traditional schools; b) medical schools maintain their educational policies over time. The value of equality was operationalized with the Equality Index (EI). To test the proposed hypotheses we used Wilcoxon's rank sum test and Mann-Whitney "U" test. We studied an intentional sample of 21 medical school in Mexico. The median of the EI for public schools between 1980 to 1989 was 4; 2 for private schools, 2 for traditional schools, and 3 for module-based schools. The only significant difference found was that between public and private schools (p < 0.05). We conclude that in public schools there is more equality of opportunities than in private ones. The results are consistent during the decade of the 80's.

Education, Medical↗
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[Progression of renal insufficiency in the pre-end-stage renal disease setting].

The rate of decline of renal function (RDRF) in the pre-end stage renal disease setting (pre-ESRD) is highly variable. Several factors have been involved as potential modifiers of renal failure progression. This retrospective study attempts to establish which were the main determinants of the RDRF in pre-ESRD patients followed in the predialysis consult. The study group consisted of 230 patients with pre-ESRD not yet on dialysis who were referred to the predialysis consult from January 1998 to July 2002. The mean follow-up time per patient was 356 days. RDRF was assessed as delta of the average of creatinine and urea clearances (CrCl-UCl). Data obtained at time of referral to the predialysis consult were analyzed as potential predictors of the subsequent RDRF. These independent variables included: demographics, comorbid conditions, main hematological and biochemical data, antihypertensive and statin treatment, mean blood pressure, and CrCl-UCl at time of referral. The predictors of delta CrCl-UCl were determined by multiple linear regression analysis. The determinants of the survival without dialysis were established by the Cox regression hazard model, adjusted to renal function at time of referral. Mean CrCl-UCl at time of referral was 10.98 +/- 2.58 ml/min/1.73 m2, and mean delta CrCl-UCl was -0.37 +/- 0.46 ml/min/1.73 m2/month. Patients with diabetic nephropathy and chronic glomerulonephritis had the fastest RDRF, while patients with ischemic nephropathy and chronic interstitial nephritis had the slowest RDRF. Seventy-five patients (46%) required EPO therapy. The best determinants of delta CrCl-UCl were: the 24-hour proteinuria (p < 0.0001), and the hematocrit at time of referral (p = 0.0024). The best determinants of the survival rate without dialysis during the study period were: the proteinuria (in g/24 hours) (R 1, 16; p < 0.0001), the hematocrit at time of referral (OR: 0.88; p < 0.0001), the treatment with EPO (OR: 0.59; p = 0.02), and the diagnosis of diabetes mellitus (OR: 1.59; p = 0.01). In conclusion, apart from the rate of proteinuria, which could represent the best marker of the RDRF in chronic renal diseases, the development of anemia was associated with faster decline in renal function.

Erythropoietin↗
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[Evaluation of 2 techniques for ventilation support during single-lung ventilation].

In a group of 22 patients undergoing thoracotomy we compared two techniques of ventilatory assistance to the nondependent lung during single lung ventilation. We simultaneously administered a 0.5% FiO2 to the dependent lung. We used a CPAP system with continuous O2 flow limited by an underwater valve at a pressure of +5 cmH2O. We performed 33 ventilatory assistances: in 15 cases to the nondependent lung (CPAP group) and in 18 patients to the lower lobe of the nondependent lung (lobar CPAP group). Evaluation of both techniques was performed by means of arterial blood gas measurement and the mean values were compared using the student's t test. During single lung ventilation the PaO2 in CPAP group increased from 85.86 +/- 22.28 mmHg to 155.52 +/- 59.54 mmHg (p less than 0.001) and in the lobar CPAP series it increased from 88.75 +/- 24.34 mmHg to 122.36 +/- 43.21 mmHg (p less than 0.01). In 11 out of the 22 patients we firstly applied the lobar CPAP and thereafter the CPAP to the whole lung in order to compare the efficacy of both techniques in the same patient. The PaO2 during single lung ventilation was 86.9 +/- 22.7 mmHg and it increased to 111.1 +/- 37.9 mmHg after lobar CPAP (p less than 0.01) ant to 163.3 +/- 64 mmHg after total lung CPAP ventilation (p less than 0.001). Our results confirm the usefulness of both techniques and they indicate that CPAP to the whole nondependent lung is the most effective.

Adult↗
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[Effectiveness of typical and atypical neuroleptics in the control of behavioral and psychopathological symptoms of dementia. Results of a retrospective study].

INTRODUCTION: Presence of disruptive behavioural and psychological symptoms in dementia (BPSD) is highly prevalent and, as a consequence, neuroleptics are frequently used in these patients to control BPSD. Several reviews have shown the clinical equivalence of different classes of neuroleptics in BPSD control, although that equivalence has been only indirectly assessed by comparing the combined results of different types of active drugs versus placebo. Thus, little is known on the comparative effectiveness, head to head, of different neuroleptics on BPSD. The aim of this study was to gather preliminary information on the effectiveness of typical (haloperidol, thioridazine) and atypical (olanzapine, risperidone) neuroleptics on BPSD. METHODS: Multicenter, observational and retrospective study using chart reviews of patients with dementia to assess neuroleptic prescriptions and clinical outcomes at 12 weeks on treatment. RESULTS: No significant differences on BPSD improvement were found by type of neuroleptic (n=78; Kruskal- Wallis exact test; p=0.47). There also were no differences by neuroleptics when the analysis was stratified by levels of cognitive decline (Kruskal-Wallis exact test; p=0.86 and 0.87 for moderate and severe levels of deterioration, respectively). Recorded side effects were worse in the haloperidol group (n=19) regarding rigidity (Fisher's exact; p=0.01), tremor (Fisher's exact p=0.03) and akathisia (Fisher's exact; p=0.03). CONCLUSIONS: Our findings support the equivalence in effectiveness of several classes of neuroleptics commonly used to treat BPSD. Nevertheless these results need to be confirmed by adequately powered randomized trials and further pharmacoepidemiological studies to assess their safety.

Aged↗
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[Battered child syndrome. X ray findings].

Child abuse or battered child syndrome is a major cause of morbidity and mortality in childhood in the United States and is not uncommon in our country. Mild to severe neurologic damage is commonly seen. Skeletal injuries, although not usually the cause of permanent damage, may constitute important medical and legal evidence of child abuse. Understanding of the mechanisms of injury in accidental and non accidental trauma helps the pediatrician and the radiologist in the diagnosis of abuse. While correct diagnosis can be suspected clinically, specific types of fractures should alert the radiologist to the likelihood of abuse or the need of additional films or clinical reevaluation of the patient. People in general, should be aware of child abuse and of the convenience of appropriate preventive measures. In addition to pediatricians and radiologists, other experts should also be directly involved in this problem, including pathologists, psychiatrists, lawyers, social workers and so on.

Abdominal Injuries↗
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[Ultrasonographic diagnosis of hypertrophic pyloric stenosis].

Hypertrophic pyloric stenosis (HPS) is one of the most common causes of abdominal surgery during the first weeks of life. The primary cause of the muscular hypertrophy is unknown and the pathogenesis is obscure. Clinically, vomiting is always present and sometimes there is a palpable pyloric mass (olive). Upper gastrointestinal tract study with barium has been the most usual method for the diagnosis. Since the first report of the use of ultrasound (US) in the diagnosis of HPS in 1977, this technique has been widely used and accepted, being by now, the diagnostic imaging examination of choice for infants in whom this abnormality is suspected. This is our experience with the use of US in 27 infants with clinically suspected HPS. In 17 cases there was US evidence of HPS and in 10 patients results were negative. We did not have false positive neither false negative results. We strongly recommend this diagnostic method for all infants under clinical suspicion of HPS.

Female↗
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[Ultrasonography in spinal dysraphism and tethered cord].

Spinal dysraphism is relatively common in children and includes a wide spectrum of congenital anomalies in the normal closure of the posterior elements of the spine. The prognosis will depend mostly on early diagnosis and treatment. Occult spinal dysraphism may present without external anomalies and the diagnosis could be suspected lately, when neurological symptoms are present and often irreversible. Occult spinal dysraphism is frequently associated to a tethered cord, most commonly secondary to the presence of a lipoma. Ultrasonography has been proven highly sensitive in the detection of intraspinal anomalies, especially in the diagnosis of tethered cord, in children under two years of age due to lack of ossification of the posterior elements of the spine. Today ultrasonography should be the examination of choice in all those patients in whom some kind of spinal dysraphism is suspected. We report our experience with three infants with occult spinal dysraphism in whom diagnosis was initially made by US and later on proved by either computed tomography, magnetic resonance or myelography. All of them had corrective surgery and neurological abnormalities were not detected afterwards.

Humans↗
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[Antimicrobial activity of orthodontic band cements].

The prevalence of enamel decalcification and caries beneath orthodontic bands, has indicated the need for a new enamel binding adhesive orthodontic cement. The purpose of this study was to evaluate the antimicrobial activity, in vitro, on Streptococcus mutans and Lactobacillus, acidophillus, of three materials used to cements the orthodontic bands. The cements studied were: Zinc phosphate cement, Glass-ionomer cement, and Policarboxylate cement. Thirty petri plates were seeded with S. mutans, and thirty with L. acidophillus; on each plate three pellet were placed, one of each cement studied. Petri plates were incubated under microaerophilic conditions at 37 C, and checked at 72 hrs. for Streptococcus, mutans, and four days for Lactobacillus acidophillus to evaluate the inhibition zone. The results were tabulated for each material. It was demonstrated that exists important variations in the antimicrobial properties of the materials studied, as in the microbial sensitivity to these cements.

Dental Cements↗
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[Congenital pulmonary lymphangiectasis].

Congenital pulmonary lymphangiectasis is a rare cause of severe respiratory distress in the newborn period and most of these patients die, usually within the first 24 hours of life. It may present as an isolated anomaly or it may be associated with other congenital abnormalities, most commonly cardiac in origin, as is the case of total obstruction of the pulmonary venous drainage. Congenital pulmonary lymphangiectasis may be also associated with lymphatic anomalies of other portions of the body or with other non-lymphatic, non-cardiac congenital malformations. Chest radiographs show more commonly that the lungs are hyperexpanded and present a diffuse interstitial reticulonodular pattern. The differential diagnosis from the radiological standpoint should include total anomalous pulmonary venous drainage and pneumonia. We present the case of a newborn infant with congenital pulmonary lymphangiectasis who died within the first 24 hours of life, emphasizing clinical, radiological and pathological findings.

Female↗
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[Mexico: reproductive behavior and social margination, 1970-1990. Elements of geographic diagnosis in reproductive health].

The lack of a definite knowledge on regional reproductive behavior characteristics hinders the evaluation of the goals stated in the General Population Law (Ley General de Población) and counteracts any efforts towards equating population growth with regional development. The present work aims at overcoming this problem. Indirect specific fertility rates and global fertility rates (GFR) were obtained by state, using census and vital statistics data for the states of Mexico during the 1970-1990 period. Reproductive behavior was related to social deprivation indexes used by PRONASOL and CONAPO for those years. A high statistically significant correlation (p < 0.01) between state social deprivation levels and the downward trends of GFR for the same decades was found. Findings evidence a general downward trend of GFR during the period of study. However, this trend was not uniform across the country. Further studies are needed to determine whether these differences are due to the various social deprivation levels rather than to the effectiveness and extension of family planning programs. Mapping these results could be useful as diagnostic elements of the reproductive behavior of the population and also generates information necessary to support social organized responses in reproductive health.

Adult↗
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[Physicians in Mexico, 1970-1990].

A study was carried out in 1970 on the distribution of medical personnel in Mexico. At that time an unequal distribution of physicians was detected, but not emphasized given the general shortage of physicians in the country. At the present time, the situation has changed. In this article the analysis of the 1990 census data using traditional indicators of availability of physicians in the country, as well as indirect criteria of physician requirements is presented. In the year of reference there were 157,407 physicians in the country, with a national average of 673 persons per physician. The distribution of physicians by state showed a great deal of variation in the number of persons per physician. For example, the state of Chiapas has 1,642 inhabitants per physician, whereas the Federal District has 292. The relation between trained and employed physicians shows another important phenomenon: there is a high percentage of physicians that do not practice clinical medicine (19.4%). Nevertheless, the number of physicians almost tripled the growth experienced by the general population, and important differences among and within states do persist. Furthermore, a new paradoxical effect has emerged, the presence of underemployment and unemployment of physicians, even in communities with greater needs for medical care. This indicates that the strategy of training more physicians has not solved the problems of accessibility and coverage, but in fact has fostered new problems and perhaps greater inequalities.

Demography↗
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[Psychosocial support in pregnancy as a strategy to promote the newborn's health].

In this project we developed a social support and health education intervention meant to answer whether or not a program of this kind, within the present medical system, can improve perinatal outcomes. A multicenter randomized controlled trial was conducted in four Latin American countries. In Mexico, the project was carried out in a third level obstetric hospital. Patients were screened between the 15th and 22nd week of gestation. Inclusion criteria were factors associated with high risk of low birthweight. A total of 620 women were recruited, randomized and followed up during pregnancy and up to the 40th day post partum. Women in the intervention group were visited four to six times during pregnancy, could use a telephone hot line and a consultation service. A poster and a pamphlet meant to reinforce health education were handed out in the first visit. A "guided tour" for women at the end of pregnancy was organized periodically. Outcomes were measured in both groups at the 36th week of gestation, post partum and 40 days after delivery. Neonatal outcomes were obtained by blind interviewers from the clinical records. Neither in the multicenter nor in the Mexican sample were we able to modify the incidence of low birthweight and prematurity. However, in Mexico we obtained positive effects on birthweight and gestational age in the whole sample and in some specific strata. These results strongly suggest the convenience of replicating the study in Mexico.

Adolescent↗
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[The biochemical and cellular bases of myocardial ischemia-reperfusion damage].

In recent years evidence has accumulated indicating a possible myocardial injury secondary to reperfusion. However, it is not exactly known whether injury, at the time of reperfusion, merely represents an acceleration of the damage resulting from ischemia, or whether there is a specific additional injury caused by reperfusion itself. Some pathological events have been associated to reperfusion such as reperfusion arrhythmias, stunning myocardium and vascular damage with no reflow. In this review we discuss the hypotheses that explain the cellular events involved in reperfusion damage: calcium overload, free radical damage and others; also we describe both the experimental models commonly used and drugs assayed in recent years to lower the intensity of this phenomenon.

Animals↗