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Biomedical subjects

E González Parra

Publications and source records attributed to E González Parra.

10 recordsLinked to original sources
PubMed2005

[Analysis of non-EU immigrant population within the hemodialys program of the region of Madrid].

Many hemodialysis patients from foreign countries arrived to be dialized in Madrid. They cames from all around the world, especially South America and Morroco. This group is younger (46.2 + 14.2 years) than the control group. Most of them initiated dialysis without a previous Nephrological check-up (62 %). In the foreign group the primary renal diseases were similar to the control group, however they also had many other health unusual problems. Most of them (71 %) started hemodialysis without ever having permanent hemodialysis vascular access, and 25 % were not able to speak spanish, or other European languages. This caused many problems in administering correct treatment.

Adolescent↗
PubMed2005

[Vascular access guidelines for hemodialysis].

Quality of vascular access (VA) has a remarkable influence in hemodialysis patients outcomes. Dysfunction of VA represents a capital cause of morbi-mortality of these patients as well an increase in economical. Spanish Society of Neprhology, aware of the problem, has decided to carry out a revision of the issue with the aim of providing help in comprehensión and treatment related with VA problems, and achieving an homogenization of practices in three mayor aspects: to increase arteriovenous fistula utilization as first vascular access, to increment vascular access monitoring practice and rationalise central catheters use. We present a consensus document elaborated by a multidisciplinar group composed by nephrologists, vascular surgeons, interventional radiologysts, infectious diseases specialists and nephrological nurses. Along six chapters that cover patient education, creation of VA, care, monitoring, complications and central catheters, we present the state of the art and propose guidelines for the best practice, according different evidence based degrees, with the intention to provide help at the professionals in order to make aproppiate decissions. Several quality standars are also included.

Arteriovenous Shunt, Surgical↗
PubMed2004

[Guidelines for quality management of dialysis solutions].

A Best Practice Guideline about Dialysis fluid purity has been developed under the leadership of the Spanish Society of Nephrology. The Guideline has established recommendations for standards for preparing dialysate: water, concentrates and hemodialysis proportioning systems. The Guideline was based on the European pharmacopoeia, the Real Farmacopea Española, the AAMI Standards and Recommended Practices, European Best Practice Guidelines for Haemodialysis (Section IV), literature reviews, according to their level of evidence, and the opinion of the expert spanish group. Two levels of quality of water were defined: purified water and high purified water (Ultra pure) and for dialysate: standard dialysate and ultra pure dialysate. Regular use of ultra pure dialysate is necessary for hemofiltration and hemodiafiltration on-line and desirable for high-flux hemodialysis to prevent and delay the occurrence of complications: inflammation, malnutrition, anemia and amyloidosis. Water, concentrates and dialysate quality requirements are defined as maximum allowable contaminant levels: chemicals (1.1.2), microbial and endotoxins: [table: see text] Monitoring frequency, maintenance and corrective actions were specified. Methods of sampling and analysis were described in appendix (Anexos). For microbiological monitoring, TSA or R2A medium are recommended, incubated during 5 days at a temperature of 30-35 degrees C. The dialysate quality assurance process involves all dialysis staff members and requires strict protocols. The physician in charge of hemodialysis has the ultimate responsibility for dialysate quality. All suggestions and questions about this Guideline are wellcome to www.senefro.org

Disinfection↗
PubMed2004

[Guidelines on hemodialysis-associated viral infections].

The viric infections influence morbi-mortality in Chronic kidney Disease patients in hemodialysis therapy and can affect to the Staff of the Units. The guides considered the most relevant virus at the present moment: C Virus, B Virus and HIV. To prevent horizontal nosocomial transmission is necessary the observance always the universal precautions in the HD units, although sometimes can appeared seroconversions and epidemic bud when exist a break of these. Is analyzed different situations with special focus in units for acute patients. The following steps under the suspicious of the epidemic bud appeared in one of the annexes together with legislation according to this case. Respect to the staff in every one of the virus is shown prevention patterns, serologic markers to perform when an accident with infected blood occur, also is considered when treatment is indicated. The guides considered too the conditions necessary for include these patients on waiting list for kidney transplantation.

Ambulatory Care Facilities↗
PubMed1996

[PSA and PSAD study in patients with renal dysfunction].

This study analyzes the changes in serum and urinary PSA values in 28 subjects; 13 with creatinine clearance under 75 ml/mn and 15 with creatinine clearance over 75 ml/mn. Both groups were compared for prostate size, measured by transrectal ultrasound, prostate weight, serum PSA (SPSA), 24h urine PSA (PSAO), PSA clearance (PSACl), serum creatinine (SCr), creatinine clearance (CrCl), PSA density (PSAD), PSA/creatinine ratio (PSA/Cr) and PSACl/CrCl ratio. Mean values of SPSA and PSAO were 4.5 +/- 0.8 and 222 +/- 29.7 ng/ml respectively, values for SCr, CrCl and PSACl averaging 1.62 +/- 0.2 mgr/dl, 71.6 +/- 6.5 ml/mn and 150.5 +/) 32.9 ml/mn. Median prostate size was 32.6 +/- 3.9 cc, with weights of 40.3 +/- 4.9 g and mean PSA density (PSAD) 0.13 +/- 0.02. The results of the homogeneity study showed that there are no significant differences between both groups with regard to the variables considered in the study. SPSA values were higher in patients with CrCl < 75; 3.4 vs 5.7, but not significantly. There are no significant differences between PSAO and PSACl values for both groups, even though PSAO levels were higher in patients with CrCl < 75 ml/min (p = 0.1). PSAD values for patients with CrCl > 75 ml/mn were lower than those for patients with CrCl < 75 ml/mn; 0.09 vs 0.17 (p = 0.08). In the entire sample, PSAD levels showed correlation with SPSA and PSA/Cr values; R = 0.63 (P = 0.0003) and r = 0.5 (p = 0.009) respectively. Also, they were significantly but inversely correlated with PSACl levels; r = - 0.5 (p = 0.006) and PSACl/CrCl; r = - 0.048 (p = 0.01). No correlation was seen between PSAD values and the following parameters; PSAO (p = 0.7), SCr (p = 0.5) and CrCl (p = 0.27). When the group of patients with CrCl < 75 ml/mn is considered, PSAD values are correlated exclusively with PSACl values; r = - 0.69 (p = 0.008) and PSACl/CrCl; r = 0.68 (p = 0.009). Our data appear to indicate that there is a certain relationship between PSAD and the renal function although the physiopathological mechanism responsible for that is unknown. Nevertheless, considering the sample size, more comprehensive studies will be necessary to obtain more convincing results.

Aged↗
PubMed1994

Serum concentrations of carboxyterminal cross-linked telopeptide of type I collagen (ICTP), serum tartrate resistant acid phosphatase, and serum levels of intact parathyroid hormone in parathyroid hyperfunction.

We have studied the levels of a new biochemical marker of bone resorption, carboxyterminal cross-linked telopeptide of type I collagen (ICTP), in 26 healthy control subjects, 15 patients with primary hyperparathyroidism (PHPT) and 17 patients with secondary hyperparathyroidism (secondary HPT). Levels of ICTP in PHPT and secondary HPT have been correlated with those of serum tartrate resistant acid phosphatase (TRAP), another biochemical marker of bone turnover, and with serum levels of intact parathyroid hormone (iPTH). The ICTP levels of the control group were 2.07 +/- 0.58 micrograms l-1, n = 26, range 1.3-3.2. They were independent of sex and age in the studied age range (30-62 years). The ICTP levels of PHPT patients were 3.5 +/- 3.5 micrograms l-1, mean +/- SD, range 0.5-12.2 micrograms l-1, significantly higher than those of control subjects (p < 0.05). We found a significant linear correlation between values of ICTP and iPTH levels (p < 0.01), between values of ICTP and serum activity of TRAP (p < 0.01) and between iPTH and TRAP levels (p < 0.01) in patients with PHPT. The ICTP levels in patients with secondary HPT were higher than those of patients with PHPT, 46 +/- 37 micrograms l-1, range 12-167 micrograms l-1 (p < 0.001) due to the impaired renal clearance of this peptide. We did not find a significant linear correlation between values of ICTP and iPTH levels in the serum of patients with secondary HPT, although we found a significant correlation between levels of ICTP and levels of TRAP, both biochemical markers of bone turnover.(ABSTRACT TRUNCATED AT 250 WORDS)

Acid Phosphatase↗
PubMed1994

Clinical usefulness of serum carboxyterminal propeptide of procollagen I and tartrate-resistant acid phosphatase determinations to evaluate bone turnover in patients with chronic renal failure.

We have studied the levels of the biochemical markers of bone formation total serum alkaline phosphatase, osteocalcin (BGP) and carboxyterminal propeptide of type I procollagen (PICP), the levels of the biochemical marker of bone resorption serum tartrate-resistant acid phosphatase (TRAP) and those of intact immunoreactive PTH (iPTH) in 30 patients at different stages of chronic renal failure (CRF), all of them without verifiable hepatopathy, and in 9 patients in hemodialysis with hepatopathy measured by the Knodell index. Sixteen control subjects were also studied. In the group of patients with CRF with or without hepatopathy, the levels of biochemical markers of bone turnover were significantly elevated with respect to those of control patients. We did not find any significant difference in the levels of these parameters between the groups with and without liver damage, in spite of the fact that TRAP and PICP are cleared mainly by the liver. Levels of TRAP and PICP correlated significantly with the other biochemical markers of bone turnover studied. The good relation observed between PICP, TRAP and the biochemical indexes of bone activity and iPTH levels suggests the clinical value of these markers in the follow-up of bone involvement in patients with CRF. On the other hand, the frequent hepatopathy found in patients with CRF does not seem to affect to a significant extent the diagnostic value of PICP and TRAP in this pathology.

Acid Phosphatase↗
PubMed1993

[Calciphylaxis in chronic renal failure].

Three cases of calciphylaxis in patients with terminal renal insufficiency are discussed. The existence of metastatic calcifications, mainly vascular, in patients with chronic renal insufficiency is frequent. However calciphylaxis is a process which is rarely found in these patients. This entity is characterized by the obliteration of small vessels with ischemia and necrosis. The exceptionality of the disease, its difficult treatment and poor evolution make calciphylaxis a bad prognostic complication which should be considered in the differential diagnosis of cutaneous lesions in patients with chronic renal insufficiency.

Aged↗