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Biomedical subjects

C M Pérez

Publications and source records attributed to C M Pérez.

16 recordsLinked to original sources
PubMed2000

Surgical versus interventional procedures in patients with multivessel coronary artery disease.

OBJECTIVE: This study examined the clinical characteristics, risk factors, indications and post-intervention complications of patients with multivessel coronary artery disease (CAD) submitted to either percutaneous transluminal coronary angioplasty (PTCA) and/or stent placement versus isolated coronary artery bypass grafting (CABG). BACKGROUND: Several studies have examined the relative safety and outcome of patients submitted to those interventional procedures compared to CABG. Limited information is available regarding that subject in Puerto Rico. METHODS: We performed a retrospective analysis of the clinical, angiographic, operative, interventional, post-operative and post-interventional data of patients submitted to those procedures in our institution from January 1998 to August 1998. There were 53 patients in the interventional group and 206 patients in the CAGB group. Comparison of quantitative variables by procedure was based on Student t test or Mann-Whitney-Wilcoxon test; categorical variables were compared using Pearson's chi-square or Fisher's exact test. RESULTS: There were no significant differences in age, body surface area, or cardiac risk factors. The most common pre-existing cardiovascular diagnosis was unstable angina. Three-vessel disease was the most common angiographic finding among CABG patients (61.7%). Two-vessel disease without left anterior descending coronary artery obstruction was significantly more common in the PTCA/Stent patients (58.5%). The vast majority (97.6%) of patients in the PTCA/Stent group and 52.4% of the CABG group had two-vessel intervention. A significantly higher frequency of complications occurred in the CABG group. However, the incidence of major complications, in both groups was not statistically different. Atrial arrhythmias were significantly more frequent in the CABG group. CONCLUSION: A larger prospective study should be conducted in order to corroborate these preliminary findings and seek effective solution to any identifiable problem.

Angioplasty, Balloon, Coronary↗
PubMed2000

Perioperative outcomes in octogenarians undergoing cardiac surgery in Puerto Rico.

With the advances in surgical techniques and the advent of an aging population, the application of cardiac surgeries has broadened to include those patients over the age of 80. In order to characterize the in-hospital morbidity and mortality of elderly patients undergoing cardiac surgery at our cardiovascular center, a retrospective review of all medical records of consecutive octogenarian patients was made. Between January 1998 and April 1999, 76 patients (mean age (SD), 82.5 (2.6)) underwent cardiac surgery, of which, 61.8% were males. Surgical procedures consisted of isolated coronary artery bypass grafting (CABG) in 64 patients, isolated aortic valve replacement (AVR) in 4 patients, combined CABG and left carotid endarterectomy in 4 patients, combined CABG and AVR in 2 patients, combined CABG and aortic aneurysm repair in 1 patient and combined AVR and aortic dissection repair in 1 patient. Surgery was elective in 51.3% of patients and seventy-one percent (54) experienced at least one postoperative complication. The most common complication was atrial arrhythmia (28) followed by low cardiac output (23) and pneumonia (16). Hospital mortality occurred in 11 (14.7%) patients, an estimate in agreement with previous published studies on octogenarians. Since the number of patients studied was small, these results require confirmation by other cardiovascular centers in the island. Further research to determine independent predictors of postoperative morbidity and mortality, to assess survival and quality of life after cardiac surgery and to evaluate cost-effectiveness considering new trends in managed health care is warranted.

Aged↗
PubMed2000

Gender differences in clinical outcome after coronary stenting.

OBJECTIVE: The purpose of this study was to determine the effect of gender differences in the clinical outcome of women and men submitted to coronary stenting at our institution. BACKGROUND: Studies regarding gender differences in outcome after invasive coronary interventions have revealed conflicting data regarding risk for complications. Some studies have pointed to female gender as a predictor of mortality and complications after those procedures. To our knowledge no such evaluation has been performed in our country. METHODS: We reviewed the medical records, cardiac catheterization and procedural data of 205 men and 122 women referred to our section that underwent coronary stenting at the Cardiovascular Center of Puerto Rico and the Caribbean from July 1, 1998 to March 30, 1999. The clinical and procedural characteristics and the immediate procedure-related complications were analyzed. Clinical events during the six-month period after the procedure were evaluated in patients that returned for follow-up to the section. Student's t-test or Mann-Whitney-Wilcoxon, when appropriate, was used to compare continuous data. The chi-square test or Fisher's exact test, was employed to compare categorical data. RESULTS: The initial procedural success and the frequency of early complications were comparable to those informed in the medical literature and not statistically significant between genders. The only statistically significant gender differences in outcome occurred in men who had higher re-hospitalization and re-intervention rates in the six-month period after the procedure. A lower mean ejection fraction and higher previous history of myocardial infarction and cigarette smoking in this group could have been related to the higher complication rate. CONCLUSION: Although the sample examined is small, its findings point to the need of a larger prospective study to further explore the possibility that the previously reported differences in outcome in men and women submitted to interventional procedures would have a stronger relation to clinical factors than to the direct effect of gender.

Cardiac Surgical Procedures↗
PubMed1999

[Methodological aspects of biostatistics and epidemiology in a clinical trial].

Various methodological issues in biostatistics and epidemiology which are relevant for the development of a clinical trial are discussed. A brief set of definitions regarding clinical trials and methods for the assignment of treatments is presented. In addition, methods to reduce the possibility of bias that may be introduced into a clinical trial are summarized. The different elements that must be included in the informed consent form are defined. General considerations for data analysis and for sample size required to obtain an adequate statistical power are illustrated. Finally, critical questions that can be used for the review of the literature on clinical trials are suggested.

Aged↗
PubMed1999

Variations in the survival probabilities of the PVC-protected red mangrove propagules: testing the encased replanting technique.

The EcoEléctrica Mangrove Planting Project, a five-year voluntary effort, has the purpose of testing a recently developed mangrove planting technique at the EcoEléctrica site in Peñuelas, Puerto Rico. The goal of the project is to provide empirical validation to promote or improve the technique to be used in recovering mangrove ecosystems in Puerto Rico and United States. The research presented herein analyzed the information collected on the first two years of the project. The proportions of remaining casings and seeds per study zone were compared using the chi-square distribution. Zone 1 had the least pipes lost while Zone 4 had the most (p < 0.05). Forty-three percent of the seeds in Zone 1 remained in the casing, while 26% remained in Zone 2 (p = 0.03). Median growth rates of seeds per study zone showed that Zone 1 had the highest median growth rates. Survival analysis described the survival experience of the seeds, and differences in survival probabilities were compared with the log-rank test. Zone 1 seeds had a better survival experience compared to Zones 2, 3 and 4 (p < 0.0001). Survival probabilities for being free of spots were over 60% during the whole study period. No significant differences were observed in the survival experience with the use-or-no use of casing extensions (p = 0.40), and the use-or-no use of nursed seeds (p = 0.26). Differences in survival probabilities might be attributed to variations in wave energy, depth or substrate conditions. This hypothesis will be evaluated in the second phase of the study.

Conservation of Natural Resources↗
PubMed1998

Early postoperative complications after coronary artery bypass grafting at the Cardiovascular Center of Puerto Rico and the Caribbean.

OBJECTIVES: This study describes the preoperative cardiovascular characteristics, intraoperative data, in-hospital complications and factors associated to procedural-related complications in patients undergoing coronary artery bypass grafting (CABG). BACKGROUND: There is a growing body of evidence of CABG safety and efficacy; however, limited data is available regarding the value of this surgical procedure in the Puerto Rican population. METHODS: We retrospectively reviewed the medical records of 200 consecutive patients submitted to CABG at the Cardiovascular Center of Puerto Rico and the Caribbean over a three-month period in 1997. Bivariate and multivariate analyses were performed to determine factors associated with the occurrence of complications. RESULTS: The most frequent cardiac risk factor was hypertension (77%); stable angina (60.5%) was the predominant cardiac clinical diagnosis. Three vessel disease with proximal left anterior descending coronary artery stenosis (42.1%) was the most common anatomical lesion. The rate of major complications such as death (3%), perioperative myocardial infarction (2%), reoperation to control bleeding (1.5%), pulmonary embolism (1%), and stroke (1%) was low and similar to the rate reported elsewhere. Multivariate analysis showed that non-use of LIMA graft, extended hospital stay, prolonged cardiopulmonary bypass time, and left ventricular dysfunction were significantly associated with the occurrence of complications (p < 0.05); on the other hand, there was a trend for older age to be associated with the occurrence of complications (p = 0.057). CONCLUSIONS: CABG is being performed with an acceptably low complication rate in this institution.

Adult↗
PubMed1998

Intelligence and genetic markers in Chilean children.

Genetic markers and total intelligence quotient (IQ) assessed by WISC (Wechsler Intelligence Scale for Children) were studied in children of both sexes from Santiago, Chile. Heterozygous boys for phosphoglucomutase 1 (PGM) and heterozygous girls for haptoglobin (Hp) had lower IQ than homozygotes. For ABO system, B girls had lower and B boys had higher IQ than children with other ABO phenotypes. These differences were highly significant with the two tailed t'-test (Student's t-test with the Welch-Satterthwaite correction for degrees of freedom), and most of them remained significant after the correction for multiple comparisons. Girls had greater variance of IQ than boys. Relationships between homozygotes and heterozygotes were found in two independent studies. Thus, the genetic relationship found here seems likely to be a true biotic effect.

ABO Blood-Group System↗
PubMed1998

Association between dietary fat and breast cancer in Puerto Rican postmenopausal women attending a breast cancer clinic.

OBJECTIVE: A pilot case-control study was conducted to examine the possible association between dietary fat intake and the development of postmenopausal breast cancer. BACKGROUND: Studies regarding the association between dietary fat intake and the development of breast cancer among postmenopausal women are lacking in Puerto Rico. METHODS: Eighteen cases and eighteen controls were interviewed to obtain sociodemographic information, medical history and dietary fat intake. A semiquantitative food frequency questionnaire containing 67 food items was used to collect the dietary information. RESULTS: Unadjusted odds ratios (OR) and their 95% confidence intervals (CI) showed a non-significant positive association for total fat intake and the development of postmenopausal breast cancer (OR = 1.57; 95% CI: 0.42-5.90, p = 0.25). The same non significant positive association was found for saturated fat intake (OR = 1.57; 95% CI: 0.42-5.90, p = 0.25). Polyunsaturated fat (OR = 1.25; 95% CI: 0.34-4.64, p = 0.37) and monounsaturated fat (OR = 1.25; 95% CI: 0.34-4.64, p = 0.37) were also positively associated with postmenopausal breast cancer, although the associations were not statistically significant. CONCLUSIONS: These results are consistent with other case-control studies that have shown non-significant positive associations between total fat and the different components of dietary fat and postmenopausal breast cancer.

Adult↗
PubMed1998

Dietary fat and breast cancer: a brief update on current knowledge.

Descriptive epidemiologic data suggest a relationship between consumption of high fat diets and breast cancer; although these data can be potentially confounded by other causative exposures. Results of published case-control and cohort studies are inconclusive. Nevertheless, dietary fat significantly affects mammary tumorigenesis in mice and rats in laboratory experiments. We will review current epidemiologic and animal studies, explain the possible mechanisms of how dietary fat may affect breast cancer, and provide preliminary dietary recommendations.

Adult↗
PubMed1994

Analysis of risk factors for gastric dilatation and dilatation-volvulus in dogs.

The Veterinary Medical Data Base was usd to conduct an epidemiologic study of gastric dilatation and dilatation-volvulus (GDV) to describe changes over time in frequency of canine hospital admissions, to identify risk factors, and to estimate their relative importance. Cases in this case-control study included 1,934 dogs with GDV that were admitted to 12 participating veterinary hospitals from 1980 to 1989. The controls were 3,868 dogs with other diagnoses that were randomly selected from the same hospitals. Frequency of GDV per 1,000 canine hospital admissions ranged from 2.9 to 6.8. The case fatality rate was 28.6 and 33.3% for gastric dilatation alone and for gastric dilatation with volvulus, respectively. Using logistic regression analysis, the odds ratio (OR) and its 95% confidence limits (95% CL) for GDV associated with purebred vs mixed-breed dogs were 2.5 and 2.1, 3.0, respectively. The risk of GDV was associated with increasing age (chi 2 = 305.6, P < 0.0001) and increasing weight (chi 2 = 627.8, P < 0.0001). Significant association of GDV risk with sex or neuter status was not found. The 5 breeds having at least 10 cases and 8 controls and with the highest risk of GDV were Great Dane (OR, 10.0; 95% CL, 6.4, 15.6), Weimaraner (OR, 4.6; 95% CL, 2.3, 9.2), Saint Bernard (OR, 4.2; 95% CL, 2.3, 7.4), Gordon Setter (OR, 4.1; 95% CL, 1.8, 9.3), and Irish Setter (OR, 3.5; 95% CL, 2.4, 5.0). The effect of increasing body weight on GDV risk was less than that of increasing ideal adult breed weight, determined by published breed standards.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMedDate not supplied

Depression scores following migraine treatment in patients attending a specialized center for headache and neurology.

OBJECTIVE: To determine the changes in clinical characteristics and depression levels among patients following treatment for migraine. BACKGROUND: Epidemiologic studies have provided consistent evidence regarding an association between migraine and depression. In Puerto Rico, however, migraine has not yet been systematically investigated. METHODS: A chart review of 144 Puerto Rican patients who presented with migraine, diagnosed according to the International Headache Society criteria, and depression over a 2-year period was performed. The level of depression, before and after migraine treatment, was evaluated using the Zung Self-rating Depression Scale. RESULTS: The mean age of patients was 37.0 +/- 14.4 years; 77.1% were women. More than half (52.8%) reported severe headache and 56.9% reported a monthly frequency of five attacks or more. Nearly 9% were using antidepressant therapy and 8% were under psychiatric treatment. The mean Zung index score at baseline was 50.6 +/- 10.9. Following treatment with triptans, the intensity and frequency of migraine and the Zung index score decreased significantly (P<.00001). A trend for a greater reduction in Zung index scores among patients receiving triptan medications for more than a year was demonstrated (P =.07). CONCLUSIONS: These results indicate that migraine treatment with triptans appears to be effective in decreasing the headache frequency and intensity, and depression levels, independent of antidepressant medication use or psychiatric treatment.

Adult↗
PubMedDate not supplied

[A comparative study of indinavir versus ritonavir for assessing the development of opportunistic diseases in adult AIDS patients].

This observational study compared the probability of developing the first opportunistic infection among AIDS adult patients attending the "Programa SIDA de San Juan" who received either indinavir plus zidovudine and lamivudine (n = 45) or ritonavir plus zidovudine and lamivudine (n = 16) between August 1, 1996 and July 31, 1997. No significant differences were observed with respect to appearance of an opportunistic infection, increase in CD4 levels and decrease in viral load between both groups during the study period. However, an increased probability of being free of opportunistic infection after 10 months was observed for the indinavir group (p > 0.05). In addition, the probability of changing or interrupting prescribed therapy was 2 times higher for patients under ritonavir (p < 0.05). These results suggest the need to confirm these findings in a larger group of patients in a controlled clinical trial and to assess the short-term and long-term effects of both therapies among Puerto Rican AIDS patients.

AIDS-Related Opportunistic Infections↗