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Biomedical subjects

J Belda

Publications and source records attributed to J Belda.

At least 37 records · Page 2Linked to original sources
PubMed2000

Addition of intravenous aminophylline to beta2-agonists in adults with acute asthma.

BACKGROUND: Aminophylline has been used extensively in acute asthma, but its role is unclear especially with respect to any additional benefit when added to beta2-agonists. OBJECTIVES: To determine the magnitude of effect of the addition of intravenous aminophylline to beta2-agonists in adult patients with acute asthma treated in the emergency setting. SEARCH STRATEGY: Studies were identified from the following sources: The Cochrane Airways Group register (derived from MEDLINE, EMBASE, CINAHL standardised searches), hand searched respiratory journals and meeting abstracts. Potentially relevant articles were obtained, and their bibliographic lists were hand searched for additional articles. The search included searches of the database up to 1999. SELECTION CRITERIA: Randomised controlled trials comparing intravenous aminophylline versus placebo in adults with acute asthma and treated with beta-adrenergic agonists. Patients could be treated with or without corticosteroids or other bronchodilators. DATA COLLECTION AND ANALYSIS: A total of 210 abstracts were identified. Two independent reviewers selected a total of 27 eligible studies for possible inclusion, in which quality assessment was performed and a third reviewer was used to adjudicate disagreements. Peak expiratory flow (PEFR) and forced expiratory volume in the first second (FEV1) data were extracted and entered in Review Manager from these studies. Information not obtained from the authors was estimated from graphs. All data were entered and double checked by two reviewers. Results are reported as weighted mean differences (WMD) or odds ratio (OR), both with 95% confidential intervals (CI). MAIN RESULTS: Fifteen trials were included. Overall, the quality of the studies was only moderate; concealment of allocation was assessed as clearly adequate in only seven (45%) of the trials. The doses of aminophylline and other medications and the severity of asthma varied between studies. There was no statistically significant effect of aminophylline on airflow outcomes at any time period. The aminophylline treated group had higher values of PEFR at 12 (PEFR 8 L/min or 2.3%) and 24 hours (PEFR 22 L/min or 6.4%), but these were not significant (p>0.05). Two subgroup analyses were performed by grouping studies according to mean baseline airflow limitation (n = 11 studies) and the use of any steroids (n = 9 studies). There was no relationship between baseline airflow limitation nor the use of steroids on the effect of aminophylline. Aminophylline treated patients reported more palpitations/arrhythmias (OR: 2.9; 95% CI: 1.5 to 5.7) and vomiting (OR: 4.2; 95% CI 2.4 to 7.4), but no difference was found in tremor or hospital admissions. REVIEWER'S CONCLUSIONS: In acute asthma, the use of intravenous aminophylline did not result in any additional bronchodilation compared to standard care with beta-agonists. The frequency of adverse effects was higher with aminophylline. No subgroups in which aminophylline might be more effective could be identified. These results should be added to consensus statements and guidelines.

Adrenal Cortex Hormones↗
PubMed2000

Reproducibility, validity, and responsiveness of a disease-specific symptom questionnaire for gastroesophageal reflux disease.

The purpose of this study was to establish the reproducibility, validity, and responsiveness of a symptom questionnaire to assess patients with gastroesophageal reflux disease (GERD). A total of 300 patients with GERD completed questionnaires before and 6 months after laparoscopic Nissen fundoplication. Forty-six GERD patients who continued on omeprazole served as controls. Lower esophageal sphincter pressure, 24-h pH, and quality of life (SF36) were measured at baseline and follow-up. Reproducibility was calculated as an intraclass correlation coefficient (ICC) from a repeated-measures analysis of variance on symptom scores (SS) on two consecutive days. Validity was established by correlating SS with 24-h pH and SF36 scores. Responsiveness was calculated as the the ratio of the mean paired difference in score in the surgical group to the within-subject variability in control subjects. Reproducibility was very high, as revealed by an ICC of 0.92. Strong correlations between SS and SF36 scores at baseline and after surgery demonstrated high cross-sectional validity. Correlation between change in SS and change in pH, SF36 pain, general health, and physical health scores demonstrated longitudinal validity. The mean (95% confidence interval) paired differences in SS were 25.6 (23.7, 27.5) in the study and 2.0 (-3.2, 7.3) in the control groups, and the responsive index was 1.0. The estimated minimally important clinical difference was 7. We conclude that the symptom score is a reproducible, valid, and responsive instrument for assessing symptoms caused by GERD.

Anti-Ulcer Agents↗
PubMed2000

Induced sputum cell counts in healthy adults.

Induced sputum cell counts provide a relatively noninvasive method to evaluate the presence, type, and degree of inflammation in the airways of the lungs. Their interpretation requires a knowledge of normal values from a healthy population. The objective was to examine the total and differential cell counts in induced sputum from a sample of healthy adults. A total of 118 healthy nonsmoking adults were studied. None had asthma or airflow obstruction (negative history, FEV(1) >/= 80% predicted, ratio of FEV(1) to vital capacity [FEV(1)/VC] >/= 80%, methacholine PC(20) >/= 16 mg/ml). Forty-six were atopic. Sputum induction produced an adequate sample in 96 subjects [53 males, mean age (range) 36 (18 to 60) yr]. The expectorate was processed within 2 h; sputum was selected, treated with dithiothreitol, filtered, and examined in a hemocytometer for total cell count and viability and on Wright-stained cytospins for a differential cell count. The mean, median (90th percentile) total cell count was 4.1, 2.4 (9.7) x 10(6) cells/g and cell viability was 69.6, 72.0 (89.7)%. The proportions of eosinophils were 0.4, 0.0 (1.1)%, neutrophils 37.5, 36.7 (64.0)%, macrophages 58.8, 60.8 (86.1)%, lymphocytes 1.0, 0.5 (2.6)%, metachromatic cells 0.0, 0.0 (0.04)%, and bronchial epithelial cells 1.6, 0.3 (4.4)%, respectively. Female gender and atopy were associated with a significant elevation of eosinophils; mean difference between male/female was 0.3% (p = 0.043) and between atopic/nonatopic 0.4% (p = 0.024). This study has identified reference values for total and differential cell counts in induced sputum of healthy adults.

Adolescent↗
PubMed2000

Long-term effects of outpatient rehabilitation of COPD: A randomized trial.

OBJECTIVE: To examine the short- and long-term effects of an outpatient pulmonary rehabilitation program for COPD patients on dyspnea, exercise, health-related quality of life, and hospitalization rate. SETTING: Secondary-care respiratory clinic in Barcelona. METHODS: We conducted a randomized controlled trial with blinding of outcome assessment and follow-up at 3, 6, 9, 12, 18, and 24 months. Sixty patients with moderate to severe COPD (age 65 +/- 7 years; FEV(1) 35 +/- 14%) were recruited. Thirty patients randomized to rehabilitation received 3 months of outpatient breathing retraining and chest physiotherapy, 3 months of daily supervised exercise, and 6 months of weekly supervised breathing exercises. Thirty patients randomized to the control group received standard care. RESULTS: We found significant differences between groups in perception of dyspnea (p < 0.0001), in 6-min walking test distance (p < 0.0001), and in day-to-day dyspnea, fatigue, and emotional function measured by the Chronic Respiratory Questionnaire (p < 0. 01). The improvements were evident at the third month and continued with somewhat diminished magnitude in the second year of follow-up. The PR group experienced a significant (p < 0.0001) reduction in exacerbations, but not the number of hospitalizations. The number of patients needed to treat to achieve significant benefit in health-related quality of life for a 2-year period was approximately three. CONCLUSION: Outpatient rehabilitation programs can achieve worthwhile benefits that persist for a period of 2 years.

Aged↗
PubMed2000

[Use of the anesthetic cream EMLA in arterial punction].

INTRODUCTION: Arterial puncture is a painful procedure requiring prior local anesthesia. Various products are available for pain relief, among them EMLA anesthetic cream. OBJECTIVE: To compare pain from simple puncture of the radial artery performed with or without application of EMLA anesthetic cream and after infiltration of mepivacaine. PATIENTS AND METHODS: A prospective, random double-blind study of 153 patients in three groups: group A, 51 patients who were applied 1 g of EMLA cream; group B, 52 patients who were applied 1 g of placebo cream; and group C, 50 patients who received infiltration of 0.2 ml of 1% mepivacaine. Pain was assessed on a 10 cm visual analog scale (0, absence of pain; 10, greatest imaginable pain). RESULTS: Pain intensity reported by the patients was 2.6 +/- 1.8 in group A, 2.9 +/- 1.8 in group B and 1.6 +/- 1.8 in group C. The results for group C were statistically different from those for groups A and B. The difference between groups A (EMLA) and B (placebo), however, was not statistically significant. CONCLUSIONS: Mepivacaine infiltration is the more effective method for minimizing pain from puncture of the radial artery. EMLA anesthetic cream is not effective against pain caused by this procedure.

Anesthesia, Local↗
PubMed1999

Low-flow anesthesia and reduced animal size increase carboxyhemoglobin levels in swine during desflurane and isoflurane breakdown in dried soda lime.

UNLABELLED: After institutional approval, we studied the effect of animal size, anesthetic concentration, and fresh gas flow (FGF) rate on inspired carbon monoxide (CO) and carboxyhemoglobin (COHb) during anesthesia in swine, using soda lime previously dried to 1 +/- 0.1% water content. To ascertain the effect of anesthesia, eight adult pigs were anesthetized with either 1 minimum alveolar anesthetic concentration (MAC) desflurane or isoflurane and, to characterize the effect of the FGF rate, it was doubled in four pigs. To determine the effect of animal size, four small and four large pigs received 1 MAC desflurane or isoflurane, and to determine the effect of the anesthetic concentration, a group of four swine was exposed to 0.5 MAC. CO and COHb concentrations were larger with desflurane (5500 +/- 980 ppm and 57.90% +/- 0.50%, respectively) than with isoflurane (800 ppm and 17.8% +/- 2.14%, respectively), especially in the small animals. Increasing the FGF rate significantly reduced peak CO and COHb concentrations resulting from both anesthetics; however, when each anesthetic was reduced to 0.5 MAC, the concentrations obtained were similar. We conclude that CO intoxication is more severe with desflurane than with isoflurane, that small animals are at higher risk for CO poisoning, and that low FGF can increase COHb concentrations. IMPLICATIONS: The present study shows that the use of desflurane with desiccated carbon dioxide absorbents in pediatric anesthesia can produce a dangerous carbon dioxide intoxication, especially with low-flow anesthesia.

Absorption↗
PubMed1999

Use of peak flow variability and methacholine responsiveness in predicting changes from pre-test diagnosis of asthma.

Asthma is usually diagnosed clinically. This study investigated how methacholine challenge and peak expiratory flow monitoring influenced change from a pretest clinical diagnosis. Records of 132 patients referred with respiratory symptoms, who subsequently had reliable measurements of both airway responsiveness (provocative concentration of methacholine causing a 20% fall in forced expiratory volume in one second (FEV1 (PC20)) and peak expiratory flow variability (PEFV) were reviewed. Initial and final diagnoses for each patient were classified as: a) definite asthma; b) possible asthma; and c) definitely not asthma. The predictive value of PEFV and PC20 regarding overall change from pre- to post-test diagnosis, change from initial diagnosis of possible or definitely not asthma, and change from initial diagnosis of definite asthma, were tested by multiple logistic regression analysis. Odds ratios for PC20 were expressed per doubling dose, and for PEFV per 5% variability. Clinical diagnosis of definite asthma and definitely not asthma were confirmed in 70% and 79% respectively. PC20, but not PEFV, predicted an overall change between pre- and post-test diagnosis. Both PC20 and PEFV independently predicted change to definite asthma. PEFV and interaction between PC20 and PEFV predicted a change in those whose initial diagnosis was definite asthma. Although both measurements showed a significant correlation, there was poor agreement between positive tests. Both peak expiratory flow variability and provocative dose of methacholine causing a 20% fall in forced expiratory volume in one second influence diagnostic decision-making in patients with a high pre-test probability of asthma.

Adult↗
PubMed1998

False-positive tests for syphilis associated with human immunodeficiency virus and hepatitis B virus infection among intravenous drug abusers. Valencian Study Group on HIV Epidemiology.

The role of HIV, hepatitis C virus, and hepatitis B virus infections in the production of biological false-positive reactions for syphilis was evaluated in two large samples of intravenous drug abusers and homosexual men attending AIDS prevention centers in Spain. A significantly increased odds ratio (OR) for false-positive tests for syphilis [OR 2.23, 95% confidence intervals (CI) 1.76-2.83] was observed for HIV-seropositive intravenous drug abusers; biological false-positive reactions were also more frequent (OR 1.73, 95% CI 1.30-2.31) among intravenous drug abusers who were hepatitis B virus seropositive but not among those who were hepatitis C virus seropositive (OR 0.90; 95% CI 0.48-1.69). Among homosexuals, the association between HIV and biological false-positive reactions was restricted to subjects who were also intravenous drug abusers, indicating the crucial role of intravenous drug abuse. Only 20.5% of intravenous drug abusers with a previous biological false-positive reaction yielded a false-positive result in their subsequent visit.

Antibodies, Bacterial↗
PubMed1998

[Our experience in treating obstructive lesions of the main airway by Nd-Yag laser resection].

We performed 164 laser resections with a neodymiumyttrium-aluminum-garnet (Nd-Yag) laser in 116 patients between January 1992 and December 1997. Seventy-eight patients had malignant neoplasms, 5 had neoplasms of intermediate malignancy and 33 had inflammatory tracheal lesions. Eighteen resections were emergency procedures. All resections were performed with the patient under general anesthesia and preferably breathing spontaneously. Immediate results varied according to the nature and location of the lesion. Treatment was palliative for tumors showing intraluminal proliferation, providing successful reopening of the airway as shown endoscopically in 70% of patients. Mean survival of the 44 patients with malignant lesions who could be followed was 29 weeks, with a median of 15.19 (range, 1-120). The tracheas of patients with inflammatory stenosis were reopened rapidly and emergency tracheostomy was avoided in all cases. One patient with malignant tracheal tumors died during the procedure due to asphyxia related to tracheal hemorrhage.

Adult↗
PubMed1998

Quality of life in patients with chronic respiratory disease: the Spanish version of the Chronic Respiratory Questionnaire (CRQ)

The aim of this study was to translate the Chronic Respiratory Questionnaire (CRQ) into Spanish and to test its measurement properties. The study was performed in 60 patients with chronic obstructive pulmonary disease (forced expiratory volume in one second (FEV1) mean+/-SD 35+/-14% of reference value). A rigorous process of forward and back translation and review produced an easily comprehensible questionnaire, which was administered together with measures of pulmonary function and exercise capacity. The patients were randomly allocated to one of two groups: 30 received respiratory rehabilitation and the other 30 received standard community care only. Weak to moderate statistically significant correlations (0.2-0.38) were found between the domains of the CRQ and pulmonary function and exercise measures. For the three CRQ domains that measure differences between patients at a point in time, Crohnbach's alpha and intraclass correlation coefficients were: fatigue 0.80 and 0.80; emotional function 0.86 and 0.68; and mastery domains 0.84 and 0.67, respectively. Scores remained stable in patients who were deemed clinically stable, and showed large statistically significant improvement (p<0.0001) in patients in the rehabilitation programme. Only low correlations were found between the changes in CRQ and the changes in pulmonary function and exercise capacity. The index of responsiveness was 0.92 for fatigue, and 0.91 for dyspnoea, emotional function and mastery. In conclusion, the Spanish translation of the Chronic Respiratory Questionnaire is likely to be useful for measuring differences between patients, and particularly for measuring the effects of intervention on quality of life in chronic respiratory disease.

Aged↗
PubMed1998

[7 new cases of HIV-2 infection recognized in Madrid in 1996 and 1997].

The infection with human immunodeficiency virus type-2 (HIV-2) is endemic in Western Africa, where it is responsible for many of AIDS cases. In Spain, 72 cases with HIV-2 until December 1997 had been reported, mainly in African immigrants. Seven of these cases (4 males and 3 females) were identified during 1996 and 1997. Five came from Western Africa and other two were Spanish, one from Alicant and the other from Vigo. Only one out of the seven patients presented clinical manifestations (Pneumocystis carinii pneumonia); the remaining patients were asymptomatic. Viral isolates from six of these patients were genetically characterized: three were subtype A, whereas those from Equatorial Guinea patients corresponded to HIV-2 subtype B.

Adult↗
PubMed1997

[Evaluation of 6 portable meters for measuring peak expiratory flow].

The aim of this study was to evaluate six peak flow meters, comparing them to a flow signal recorded under laboratory and clinical conditions (LC and CC, respectively). The six peak flow meters studied were the PF-Control (A), the Personal Best (Healthscan) (B), the logarithmic scale and linear Vitalographs (Vitalograph) (C and D), the Miniwright (Airmed) (E), and the Assess (Healthscan) (F), LC: Readings were compared to those obtained with a computer-controlled syringe attached to a servomechanism (Pulmonary Waveform Generator System) at flow levels of 185, 302 and 595 L/m before and after clinical measurements. CC: Readings from each model, taken randomly and consecutively, were compared with those obtained by pneumotachometer in 50 individuals with different air flow levels (range 86 to 888 L/min), ending by repeating the measurement procedure with the first device used. The LC results were as follows: precision varied among the six models from 0.9% (F) to 9.4% (E), and in no case was there a statistically significant difference from the servosyringe reading; reproducibility (coefficient of variation) ranged from 0.7% (F) to 3.3% (B); stability after clinical testing showed results that differed from those of the servosyringe in a range of -18.3 L/min (A) to +16.7 L/min (B) and the difference was significant only for device B. The CC results were as follows: in comparison with the pneumotachometer readings, percent error was within NHLBI limits for devices A and B in excess of the limits for the other peak flow meters. Analysis of concordance showed that differences were related to level of flow for all devices except F and that measurement errors conformed to an equation of linear regression. We conclude that all the studied models give readings that are biased in direct proportion yo the flow measured. Precision was good and the devices remained stable over more than 200 readings, such that peak flow meters are appropriate for repeated measurements in a single patient.

Evaluation Studies as Topic↗