Biomedical subjects

J Alvarez Hernández

Publications and source records attributed to J Alvarez Hernández.

11 recordsLinked to original sources

PubMed2006

[Global therapeutic approach of muscle dysfunction in COPD].

Chronic obstructive pulmonary disease (COPD) is a progressive condition characterized by the presence of chronic obstruction and incomplete airflow reversibility. It is a disease with increasing prevalence and high sociosanitary cost. Hyponutrition and muscle dysfunction are two determinant factors of clinical severity and disease prognosis. The close relationship between weight loss or hyponutrition and mortality has been known for several years. Today we know that muscle mass is better predictor than weight of survival in patients with moderate to severe COPD. Several factors are implicated in the development of hyponutrition and deterioration of muscle structure and function. Slowing "muscle wasting" in COPD patients requires designing new integrated therapeutic strategies. Health care programs for COPD patients include multidisciplinary care of the main areas involved in the course of the disease. The main lines address: cigarette smoking cessation, pharmacotherapy, oxygen therapy, rehabilitation, nutritional support, surgery, travels, intercurrent periods, and palliative care. Pulmonary rehabilitation (PR) should be seen as part of a multidisciplinary program in individualized care of each COPD patient, aiming at optimizing his/her physical and social autonomy. Physical training, psychosocial intervention, patient education, and support groups for patients and relatives and friends, smoking cessation, oxygen therapy, appropriate oral feeding, and nutritional support are part of that therapeutic strategy allowing for an integral approach of muscle dysfunction in COPD patients.

Humans↗

PubMed2006

Clinical use of enteral nutrition.

Enteral Nutrition is among the most developed disciplines in modern Medicine. Technological advances, a better knowledge of malnutrition physiopathology and its involvement in the evolution of several clinical entities have made it possible to improve the nutritional attention paid to our patients. The use of EN has expanded as a first choice practice in patients with undernutrition or at risk of undernutrition that have a minimally functional intestine and are unable to cover their total calorie and protein requirements with natural or supplemented diets. Terms like "medical food" or "organ- or system-specific nutrition" or "pathology-specific nutrition" have revolutionized the EN field in the last 20 years with the emergence of specifically defined formulations. EN has been shown to be cost-effective in patients with malnutrition when the indication is established early. Home and Ambulatory Artificial Nutrition techniques are administratively regulated and, as they are widespread in our country, they allow some cost reductions in certain processes. Occasionally, the introduction, use or withdrawal of EN may constitute a situation of ethical dilema that should be avoided by making use of respect, companionship and shared information between the health team, patients and their substitutes.

Enteral Nutrition↗

PubMed2005

[Epidemiological and clinicopathological study of thyroid cancer in east Madrid].

OBJECTIVES: To analyze the incidence, clinical and histopathological manifestations, surgical complications, and prognostic factors of thyroid cancer in the east Madrid population. PATIENTS AND METHODS: Retrospective analysis of 141 consecutive diagnosed of thyroid cancer in our area between 1985 and 2001. Median follow-up was 4,5 years. RESULTS: The annual incidence rate was 4.74/100,000 inhabitants and the female:male proportion 3.5:1. The average age of patients at diagnosis was 44.5 years and nodular goiter was the principal type of clinical presentation (74.5%). The most frequent histological variant was papillary thyroid carcinoma (69%). Total thyroidectomy was carried out in 86% patients. 9.6% patients suffered permanent hypoparathyroidism and 3.3% paralysis of recurrent laryngeal nerve. Radioactive iodine ablation of remaining thyroid was carried out in 91 patients. Residual disease or local recurrence was observed on follow-up in 21% of patients, and metastasis at a distant site in 9%. 7.9% died along follow-up. The principal prognostic factors for metastasis or death were age, histological type, tumor size, local invasion and existence of metastasis at the time of diagnosis. CONCLUSIONS: The incidence of thyroid cancer in our population was high, especially in women. Although the proportion of postsurgical complications was elevated, global prognosis is good and some factors related to it have been identified. Increase of thyroglobulin plasma level at follow-up is a good recurrence indicator of the disease, especially with regard to distant metastases.

Adult↗

PubMed2000

[Clinical ethics and nutritional support].

Artificial nutrition is a modern technique enjoying a great boom of late. Regulations on the use of important clinical and technological advances in connection with nutritional support in certain groups of patients represent one of the ethical problems most often posed in daily medical practice. Terminal patient and those with irreversible neurological damage are population groups at risk of these ethical problems when it comes to the prescription, withdrawal or omission of artificial nourishment and hydration. The establishment of certain guidelines in order to resolve the ethical problems arising seems to be a complex process. So far, no consensus has been reached among doctors, with no clear legal framework and no universally accepted ethical principles. It is necessary to ensure the consideration of all the circumstances and parties coming into conflict in order to find the best solution for all concerned by means of shared decision-making.

Ethics, Medical↗

PubMed1999

[Nutrition in AIDS].

The infection by HIV continues to be the most aggressive pandemic of our century, with a high economical, social, and health care cost. In the last years the development of new, highly effective therapies has made it possible to change the prognosis, the quality of life, and the survival of many patients. However, the associated malnutrition continues to appear, with dramatic consequences. It affects between 50 and 90% of the seropositive patients. Its origin is multi-factorial and its early detection allows positive therapeutic responses to be obtained, with nutritional repletion, if the correct treatment is given. The future of the nutritional therapeutic approach in patients with HIV infection passes through a combined therapy that includes: nutritional education, drugs, and nutritional support.

AIDS-Related Opportunistic Infections↗

PubMed1996