PubMed Health⌕ Search

Biomedical subjects

C R Herrera

Publications and source records attributed to C R Herrera.

10 recordsLinked to original sources
PubMed2005

[Intradural ropivacaine for cesarean section: choosing the appropriate dose].

UNLABELLED: The trend in spinal administration of local anesthetics is to use small doses. The aim of this study was to compare 2 minimum doses of ropivacaine administered by intradural infusion for cesarean section. MATERIAL AND METHODS: After the study was approved by the ethics committee, 64 women scheduled for cesarean delivery were enrolled. The patients were randomly allocated to 2 groups: a group of 32 women received 7.5 mg of 0.75% ropivacaine (ROP 0.75%) and another group of 32 received 10 mg of the anesthetic at a concentration of 1% (ROP 1%). Both groups received 25 microg of fentanyl. Parameters assessed were time until the block reached T6, time until the highest point was reached, hemodynamic changes, incidence rates of hypertension and bradycardia, ephedrine and atropine requirements, time until recovery of motor function, duration of analgesia, time until regression of block to T10, degree of muscle relaxation, patient satisfaction, and incidence of adverse side effects. RESULTS: No patients were excluded from the study. It was necessary to provide a rescue dose in 16% of the cases in the ROP 0.75% group (P<0.05). The incidence of hypotension was higher in the ROP 1% group than in the lower-dose group (60% vs 28%) and ephedrine requirements were greater (16.56 [SD, 18.85] vs 7.96 [15.44] mg; P<0.05 in both cases). There were no significant differences in other parameters. CONCLUSION: There was greater need for a supplementary dose of local anesthetic and a lower incidence of hypotension in the ROP 0.75% group. The level of anesthesia was satisfactory for all patients in the ROP 1% group but the incidence of hypotension was higher.

Adult↗
PubMed1999

Abuse of Hispanic elders.

The nature, extent, and consequences of Hispanic elder abuse are described infrequently and often underconsidered. We reviewed information of 16,677 Hispanic elders living in the community who were abused between 1991 and 1995; these were based on valid cases reported to the Adult Protective Services (APS) office in Texas. Data did not include nursing home victims. Hispanic elders accounted for 20.6% of all elderly cases reported to APS. A 10% to 20% annual increase was seen over each of the past 5 years. Self-neglect was the most commonly identified form of abuse (63.2%). Cases with more than 1 allegation were common. The most common perpetrators (excluding self) were adult children (44.6%). Women were twice as likely as men to suffer abuse of any kind. Reluctance of victims to become involved in services to ameliorate their situations is a major barrier to effective intervention. Strategies to prevent abuse of Hispanic elders are needed and should focus on known characteristics of the abused and abusers.

Aged↗
PubMed1995

Baldness and coronary heart disease rates in men from the Framingham Study.

The authors assessed the relation between the extent and progression of baldness and coronary heart disease. Baldness was assessed twice, in 1956 and in 1962, in a cohort of 2,017 men from Framingham, Massachusetts. Extent of baldness was classified in terms of number of bald areas: no areas bald (n = 153), one area bald (n = 420), two areas bald (n = 587), and all areas bald (n = 857). Men who were assessed both times and who had two or fewer bald areas during the first evaluation were classified into one of three groups: "mild or no progression," "moderate progression," or "rapid progression." The cohort was followed for up to 30 years for new occurrences of coronary heart disease, coronary heart disease death, cardiovascular disease, and death due to any cause. The relations between the extent and progression of baldness and the aforementioned outcomes were assessed using a Cox proportional hazards model, adjusting for age and other known cardiovascular disease risk factors. Extent of baldness was not associated with any of the outcomes. However, the amount of progression of baldness was associated with coronary heart disease occurrence (relative risk (RR) = 2.4, 95% confidence interval (CI) 1.3-4.4), coronary heart disease mortality (RR = 3.8, 95% CI 1.9-7.7), and all-cause mortality (RR = 2.4, 95% CI 1.5-3.8). Rapid hair loss may be a marker for coronary heart disease.

Adult↗
PubMed1994

Hypertension in the elderly. Implications and generalizability of randomized trials.

OBJECTIVE: To estimate morbidity and mortality benefits of drug therapy for hypertensive elderly subjects, compare these benefits with effects in younger subjects, and provide a framework for generalizing results derived from trials to actual patients. DATA SOURCES: A literature search using MEDLINE from 1966 to 1993, references from reviews and trial articles, and experts. STUDY SELECTION: Randomized trials lasting at least 1 year that evaluated effects of drug treatment on morbidity and mortality outcomes in hypertensive persons. DATA EXTRACTION: Four independent reviewers appraised protocol characteristics and quality of selected trials. DATA SYNTHESIS: There were 13 trials involving 16,564 elderly persons (age 60 years and older). The prevalence of cardiovascular risk factors, cardiovascular disease, and competing comorbid diseases was lower among trial participants than the general population of hypertensive elderly persons. When the six large high-quality trials were combined, trial results showed 43 subjects (95% confidence interval [CI], 31 to 69) and 61 subjects (95% CI, 39 to 141) needed to be treated for 5 years to prevent one cerebrovascular event and one coronary heart disease event, respectively. Including the other seven trials did not change the results significantly. Only 18 subjects (95% CI, 14 to 25) needed to be treated to prevent one cardiovascular event (cerebrovascular or cardiac). Twelve trials in primarily younger and middle-aged adults involved approximately 33,000 persons. For all outcomes except cardiac mortality, two to four times as many of the younger subjects as the older subjects needed to be treated for 5 years to prevent morbid and mortal events. No significant effect on cardiac mortality was seen among younger subjects, while 78 older subjects (95% CI, 50 to 180) needed to be treated to prevent a fatal cardiac event. CONCLUSIONS: Randomized trials demonstrate that treating healthy older persons with hypertension is highly efficacious. Five-year morbidity and mortality benefits derived from trials are greater for older than younger subjects. Extrapolating benefits from trials to individual patients is difficult, but should take into account multiple issues including the patient's risk factors, preexisting cardiovascular disease, and competing comorbid illnesses.

Age Factors↗
PubMed1992

Feasibility study of surveying the adverse drug reaction surveillance systems in a large community of hospitals.

OBJECTIVE: To determine the feasibility of accurately assessing the types of hospital adverse drug reaction (ADR) surveillance systems. DESIGN: Cross-sectional survey by mailed, self-administered questionnaire followed by selected verification interviews. SETTING: Harris County, Texas. PARTICIPANTS: All hospitals in the county with different pharmacy directors. MAIN OUTCOME MEASURE: Self description of surveillance system and number of ADRs reported. RESULTS: Forty-nine of 61 hospitals (80 percent) responded to a questionnaire. Forty-seven (96 percent) of the responding hospitals collected information on ADRs with 11 (22 percent) describing their surveillance system as active. Those individuals most often cited as responsible for ADR surveillance included pharmacists, quality assurance personnel, and nurses. Data were verified by personal interviews for 10 hospitals. The number of ADRs reported during the interviews was significantly lower than that reported in the questionnaires. Overall, the reporting of fatal and severe ADRs were more reliable than the reporting of moderate ADRs. These differences were the result of inadequate documentation and the lack of a uniform definition of ADRs. CONCLUSIONS: These data suggest that a large-scale ongoing survey of surveillance systems and reported adverse event rates has limitations and the reliability of data derived from a questionnaire should be verified. To improve the accuracy of surveys used to monitor hospital ADR surveillance systems, it is essential to develop reliable definitions for classifying ADRs and surveillance methods, as well as accurate measures of ADR documentation procedures.

Adverse Drug Reaction Reporting Systems↗
PubMed1992

A nationwide investigation of a possible protamine drug-product defect.

OBJECTIVE: To follow-up a report submitted to FDA Spontaneous Reporting System, we investigated the hypothesis that there was not a striking increase in unexpected deaths within four hours after elective coronary artery bypass surgery associated with protamine sulfate use. DESIGN: Surveys were mailed to clinical pharmacists at 521 hospitals participating in the Drug Surveillance Network. Questionnaires were to be completed with the assistance of cardiac surgeons and anesthesiologists. Hospitals responding with a suspected problem with protamine were contacted via telephone. RESULTS: Surveys were received from clinical pharmacists at 380 hospitals (73 percent response rate) and 29 hospitals reported the occurrence of potential problems associated with protamine during coronary artery bypass graft surgery. Telephone interviews of the positive responders yielded six cases of possible myocardial decomposition potentially associated with protamine. There was no association with a specific distributor, however, and none of the hospitals reported a dramatic increase in serious adverse events around the time of index cases. CONCLUSIONS: There was no evidence of a widespread public health problem with protamine and a product recall was not necessary. The high response rate and the ability to follow-up with telephone interviews suggests that the Drug Surveillance Network is an effective mechanism for investigating possible outbreaks of serious adverse events in the hospital setting.

Adverse Drug Reaction Reporting Systems↗
PubMed1990

Is baldness a risk factor for coronary artery disease? A review of the literature.

A literature search identified eight articles containing data on both baldness and coronary artery disease (CAD). Three of these articles described case-control studies that showed a positive relationship between baldness and CAD when controlling for CAD risk factors. Three other case-control studies showed no such relationship, but these did not control for CAD risk factors. The results of two cohort studies were inconclusive. Insufficient data were available from these studies to analyze possible relationships between baldness and CAD risk factors themselves. Overall, the data reviewed suggest that a small risk of CAD due to baldness may exist, but this risk is smaller than that of well-known CAD risk factors such as smoking and hypertension. Future research should emphasize proper control for age and CAD risk factors.

Alopecia↗
PubMedDate not supplied

Long-acting diltiazem CD is safe and effective in a hypertensive Mexican-American population.

STUDY OBJECTIVE: To evaluate the safety and effectiveness of diltiazem CD for reducing blood pressure in Mexican-American patients with mild to moderate hypertension. DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: Twelve clinical sites in the United States. PATIENTS: Patients with baseline diastolic blood pressures between 95 and 115 mm Hg. INTERVENTIONS: Patients were treated with an average daily dose of diltiazem CD 246 mg (60 patients) or placebo (58 patients) to achieve a trough diastolic blood pressure below 90 mm Hg. MEASUREMENTS AND MAIN RESULTS: Diltiazem CD significantly reduced mean diastolic blood pressure compared with placebo, -8.2 versus -4.1 mm Hg, respectively (p=0.0025). Diastolic blood pressure below 90 mm Hg or a reduction of 10 mm Hg or more was achieved by 57% of diltiazem CD versus 28% of placebo recipients. Systolic blood pressure and heart rate were also reduced with diltiazem CD. Adverse events were mild, with similar frequency for diltiazem CD (15%) and placebo (19%). CONCLUSION: Diltiazem CD is safe and effective in hypertensive Mexican-Americans, and diastolic blood pressure reductions compare with those in non-Hispanic white patients.

Adolescent↗