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Biomedical subjects

E Andrés

Publications and source records attributed to E Andrés.

At least 19 recordsLinked to original sources
PubMed2006

Peripheral leukocyte response to oncological radiotherapy: expression of heat shock proteins.

PURPOSE: To study Heat Shock Proteins (HSP) expression in patients subjected to radiotherapy and their potential use as biomarkers for radiation tolerance. An evaluation is also made of whether irradiated volume is critical to the outcome of normal tissue injury using polymorphonuclear neutrophils as biosensors, and whether HSP antibodies (Ab) may be involved in post-radiotherapy disease. MATERIAL AND METHODS: Twelve patients receiving the same total dose of radiotherapy, but in three different volumes, and four healthy volunteers used as controls were analysed. hsp27 and 70i mRNA were determined by Reverse Transcription-Polymerase Chain Reaction (RT-PCR) and Southern-blot, HSP by flow cytometry, and HSP-Ab by Enzyme-linked Immnoadsorbent Assay (ELISA). The clinical protocol included radiation related toxicity based on clinical and analytical scales. RESULTS: Radiotherapy caused hsp downregulation, maximum in patients with the largest irradiated volumes, and a decrease in intracellular HSP content. Patients with greatest intraleukocyte HSP levels before treatment suffered more severe radiation morbidity. Patients with endocrine neoplasms presented the highest HSP-Ab titers. CONCLUSIONS: Radiotherapy downregulates hsp27 and 70i, which would enhance radiosensitivity. HSP content prior to treatment is suggested as a prognostic biomarker for radiation tolerance, with circulating leukocytes as biosensors. HSP-Ab may be biomarkers of tumor disease, but do not seem to be involved in the morbidity of acute post-radiotherapy disease, which is closely related to the volumes irradiated.

Aged↗
PubMed2005

[Is conventional hemodialysis an appropriate dialysis?].

Conventional hemodialysis, three sessions per week through a low-flux membrane, is the dialysis method most widely used. However, its efficacy is limited. The concept of dialysis adequacy exclusively based on the concept of Kt/V is too restrictive. Other solutes such as middle molecules should also be considered. Parameters such as phosphate and hypertension are very difficult to control with the conventional schedules. Observational studies demonstrate both a high morbidity and mortality. It is necessary a qualitative leap forward from the current concept of "adequate dialysis" to a more modern of "optimal dialysis". Different strategies than those shown in recent prospective studies are needed to achieve that goal.

Adult↗
PubMed2005

[New therapy strategies in secondary hyperparathyroidism on dialysis (I): new concepts, new treatments].

Secondary hyperparathyroidism (SHP) is still an early and frequent complication of chronic renal disease (CRD). Currently, CRD is an independent cardiovascular risk factor, and calcium-phosphorus metabolism is one of the modifiable related factors. In this first article, we summarize the recent SHP treatment paradigm shift in dialysis patients, derived from the better knowledge and understanding of vascular calcification. We analyze the most recent guidelines (K/DOQI), and describe the general implications of hyperphosphatemia, as well as our therapeutic approach with phosphorus-binders. Since sevelamer additionally presents some pleiotropic effects and it attenuates the progression of vascular calcification, we consider it in the first-line of treatment despite it is not yet demonstrated a survival benefit. We also minimize the use of elemental calcium to a maximum of 1000 to 1500 mg/day. Lanthanum carbonate may well be an important therapeutic agent in the near future, especially if security concerns related to metal accumulation are overcome. Ferric citrate, colestilan and nicotinamide may soon play a role. All these drugs, isolated or in combination, are important in the treatment of SHP since a great deal of its success and the avoidance of some dialysis-related complications depend on an efficient phosphorus control.

Algorithms↗
PubMed2005

[New therapeutic strategies in secondary hyperparathyroidism on dialysis (II): vitamin D analogues and calcium-mimetics].

Secondary hyperparathyroidism (SHP) is a frequent complication of dialysis patients. In this second article we will analyze the new vitamin D analogs, capable of decreasing parathyroid hormone (PTH) levels with a lower effect on intestinal calcium and phosphorus absorption. Among other advantages described in the experimental setting, paricalcitol shows a survival benefit in dialysis patients as compared to calcitriol, at least in retrospective studies, and thus it became our first-line vitamin D derivative. Calcimimetics are unique since they decrease PTH levels without increasing serum calcium and phosphorus. Actually, calcium and phosphorus decrease in a significant number of patients. These drugs will soon be authorized in Spain, and we describe the better achievement of K/DOQI guidelines as well as other beneficial effects observed in the experimental animal with them. Finally, we mention the potential benefit of mild metabolic acidosis, the use of bisphosphonates, the role of bone morphogenetic protein BMP-7, and the use of teriparatide. The future treatment of SHP will probably require the independent management of calcium, phosphorus, vitamin D and PTH. Thus, low-dose combined treatments with selective drugs may prove more effective than sequential therapies.

Animals↗
PubMed2003

[Influence of early or late referral to nephrologist over morbidity and mortality in hemodialysis].

OBJECTIVE: We studied the influence of early vs late referral to nephrologist of patients with chronic renal failure over clinical situation at the onset of hemodialysis and outcome. SUBJECTS AND METHODS: From january 1994 to december 1998, 139 patients started hemodialysis for end-stage renal disease at the Hospital General de Albacete, all of them included in the study and clinical follow-up concluded in december 2001. Patients with rapidly progressive glomerulonephritis were excluded. Early (ER) and late referral (LR) were defined by the time of first nephrology encounter greater than or less than 6 months respectively, before iniciation of hemodialysis. RESULTS: 106 patients (76.25%) were referred early; mean follow-up time 6.3 +/- 4.5 years. 33 patients (23.74%) had late referral, follow-up time was less then six months, 18 patients were followed during less than 4 weeks. There were no differences in demographic data and comorbid conditions between LR and ER patients (age, cardiac and vascular disease, diabetes, neoplasia...). Mean plasma concentration of creatinine and urea was significantly greater, whereas hematocrit and albumin were less in the LRA than the ER group. Emergency dialysis through central vein catheterisation was more frequent in the LR group. Number of admissions and duration of hospital stay were higher in the LR group. No significant differences in nutrition, dialysis doses or anemia were found between the two groups after 6 and 12 months of hemodialysis. Long term outcome was similar in both groups: no significant differences were found in percentage of patients transplanted or deceased after 3 years of treatment. Survival analysis failed to show a difference between ER and LR groups (mean survival time was 73.6 +/- 4.3 months and 73.0 +/- 6 months respectively). CONCLUSION: Late referral to the nephrologist is associated with increased early morbidity vs early referral, although long term outcome is not worse if predialysis comorbid conditions are comparable and dialysis care achieve equal results in dialysis doses, nutrition and anemia in both groups in the first months of treatment. Improvement of outcome of patients referred early to the nephrologist will depend on the adoption of preventive measures over comorbidity factors that should be applied in early stages of renal disease.

Female↗
PubMed2001

Observation of high-energy neutrinos using Cerenkov detectors embedded deep in Antarctic ice.

Neutrinos are elementary particles that carry no electric charge and have little mass. As they interact only weakly with other particles, they can penetrate enormous amounts of matter, and therefore have the potential to directly convey astrophysical information from the edge of the Universe and from deep inside the most cataclysmic high-energy regions. The neutrino's great penetrating power, however, also makes this particle difficult to detect. Underground detectors have observed low-energy neutrinos from the Sun and a nearby supernova, as well as neutrinos generated in the Earth's atmosphere. But the very low fluxes of high-energy neutrinos from cosmic sources can be observed only by much larger, expandable detectors in, for example, deep water or ice. Here we report the detection of upwardly propagating atmospheric neutrinos by the ice-based Antarctic muon and neutrino detector array (AMANDA). These results establish a technology with which to build a kilometre-scale neutrino observatory necessary for astrophysical observations.

Journal Article↗
PubMed2000

[The community activity of a hospital geriatrics service: a practical example of coordination between primary and specialized care].

OBJECTIVES: To describe the management of the geriatric hospital home assessment team to support at primary care in the need of health of geriatric patients. DESIGN: Prospective observational study. SETTING: 5-North health district from Madrid. PARTICIPANTS AND METHODS: All patients evaluated at home and the coordination activities between primary care and hospital geriatric service, developed by the geriatric assessment team between january 1997 at december 1999. Inquiry to primary care physicians about the usefulness of geriatric hospital home assessment team. MAIN RESULTS: 524 patients was assisted at home by the geriatric assessment team to request primary care (58.4% at all patients attended), 83.24 +/- 7.21 years old (68.1% females), with pluripathology (4.02 +/- 1.86 diagnostics) and polypharmacy (4.95 +/- 2.8), moderate-severe functional disability (Barthel Index < 60 at 65% and Red Cross functional disability > 2 at 74.4%) and frequently cognitive impairment (41.2% with Pfeiffer > 5). The main reasons of primary care to consult was functional impairment (28.4%), medical process assessment (16.2%), geriatric assessment (13.2%), skin ulcers (13.2%) and behavioral disorders (10.8%). 865 telephone call and 178 meeting in health center of primary care for consultation or medical management or for coordinating medical management was attended. 62% of primary care physician inquired to answer back. The belief of 100% answers was about de usefulness of the geriatric assessment team activity, mainly because their specialization on geriatric care (76.7%) and their responsibility of the hospital resources (65.1%). CONCLUSIONS: The activity of geriatric hospital home assessment team is useful as support of primary care on assessment and management geriatric patients in the community and coordinate hospital and primary care to resolve health problems in this population.

Aged↗
PubMed1998

[Diagnostic value of Gram staining of peri-catheter skin and the connection in the prediction of intravascular-catheter-related bacteremia].

BACKGROUND: To evaluate the diagnostic value of Gram stain of pericatheter skin swabs and the intravascular device hub in detecting catheter-related bacteremia (CRB) in critically-ill patients. METHODS: Over a 12-month period, 170 intravascular catheters (> 7 days in place) suspected as being the primary source of CRB were prospectively examined in adult patients admitted to 10 intensive care units of different hospitals in Spain. Blood cultures, Gram staining and culture of swabs obtained from skin entry side and catheter hub were performed before catheter removal. A semiquantitative culture of the catheter tip was carried out. Catheter-associated bacteremia was considered to be present if the same organism was isolated from the catheter tip, skin and/or hub, and blood cultures. RESULTS: The incidence rate of CRB was 15%. Staphylococcus epidermidis was the most frequently isolated microorganism. Considered together, the sensitivity, specificity, positive predictive value and negative predictive value for Gram staining of the skin and hub were 80, 81.9, 35.3 and 97.1%, respectively. CONCLUSIONS: The Gram stain of skin and hub swabs has a great utility in predicting CRB, specially in the absence of microorganisms. Gram stains of the above mentioned sites could be recommended as an easy and fast method to rule out the presence of CRB.

Adult↗
PubMed1996

[Goodpasture's syndrome with negative renal immunofluorescence].

The diagnosis of Goodpasture's syndrome is established by the clinical setting of diffuse alveolar hemorrhage and glomerulonephritis, and the demonstration of circulating or tissue-bound antibasement membrane antibodies. However, cases of Goodpasture's syndrome limited either to the lungs or kidneys have been reported. The absence of immune deposits from renal biopsy specimens of a patient with Goodpasture's syndrome, even with normal renal function, is exceptional. We report here a case of Goodpasture's syndrome characterized by direct immunofluorescence staining of the transbronchial biopsy specimen, and with direct negative immunofluorescence on renal biopsy specimen.

Adult↗