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Biomedical subjects

J Garay

Publications and source records attributed to J Garay.

At least 19 recordsLinked to original sources

Monitoring in a Lotka-Volterra model.

The problem of monitoring arises when in an ecosystem, in particular in a system of several populations, observing some components, we want to recover the state of the whole system as a function of time. Due to the difficulty to construct exactly this state process, we look for an auxiliary system called an observer. This system reproduces this process with a certain approximation. This means that the solution of the observer tends to that of the original system. An important concept for this work is observability. This means that from the observation it is possible to recover uniquely the state process, however, without determining a constructive method to obtain it. If observability holds for the original system, it guarantees the existence of an auxiliary matrix that makes it possible to construct an observer of the system. The considered system of populations is described by the classical Lotka-Volterra model with one predator and two preys and the construction of its observer is illustrated with a numerical example. Finally, it is shown how the observer can be used for the estimation of the level of an abiotic effect on the population system.

Animals↗

Monitoring weight daily blocks the freshman weight gain: a model for combating the epidemic of obesity.

BACKGROUND: The Tissue Monitoring System (TMS) is an algorithm that estimates changes in body tissue from a series of daily weight measures. It is intended to provide people with a feedback of changes in their tissue weight so they may have a basis for estimating how much they would have to change their intake or expenditure to maintain their weight at a prescribed level. We tested the effectiveness of the TMS to prevent freshmen from gaining weight during their first semester in college. METHODS: In two similar but independent studies (Fall 2002, 2003), female freshmen college students were given analog bathroom scales and instructed to weigh themselves each morning immediately after rising from bed, then e-mail their weight to our staff. After 7 days, a linear function was performed on the most recent 7 days of the weight-day function for each participant. In the first study, the slope of this function was e-mailed back to the participants. In the second study, the difference between last point and the original weight was determined, using linear regression techniques, converted to calories, and the information was e-mailed back to the participants. Control participants in both studies were weighed at the beginning and the end of the semester. RESULTS: The untreated controls gained 3.1+/-0.51 kg and 2.0+/-0.65 kg, respectively (P<0.01 for both studies), whereas weight gain of the experimental groups was 0.1+/-0.99 kg and -0.82+/-0.56 kg, values that were not significantly different than zero. CONCLUSIONS: The TMS appears to be an effective technique to help female college freshmen resist gaining weight in an environment that is conducive to weight gain. These results suggest that the TMS may be a useful method to help curb the slow increase in the prevalence of overweight and obesity that is characteristic of all industrialized societies.

Adolescent↗

Results of a national study on anti-mycobacterial drug resistance in El Salvador.

SETTING: The DOTS strategy was introduced in El Salvador in 1997 and had become fully implemented countrywide by 2001. Previously, many deficiencies were identified in the management of patients with tuberculosis (TB). OBJECTIVE: To ascertain the prevalence of Mycobacterium tuberculosis resistant to first-line drugs. DESIGN: A national prospective survey was carried out in 2001 using the standardised World Health Organization/ International Union Against Tuberculosis and Lung Disease model. RESULTS: A total of 711 cultures were analysed (59% of total smear-positive cases); 611 were never treated and 100 were previously treated patients. The study showed resistance rates to isoniazid and rifampicin, either alone or combined (multidrug resistance, MDR), of 1.3%, 1.1% and 0.3%, respectively, in never treated patients, and 12%, 13% and 7%, respectively, in previously treated patients. CONCLUSION: The low rates of MDR-TB in El Salvador are puzzling, as out-patient DOTS was introduced only recently and fixed-dose combination tablets have not been used.

Age Distribution↗

[Psychogenic cough: Another etiology for persistent cough].

The most common causes of persistent cough are upper respiratory tract disease (postnasal drip syndrome, infections) and asthma. In the last year, six patients (four boys and two girls), aged 7-12 years old, with a diagnosis of hard-to-manage asthma and/or persistent cough were referred to our department. All the patients had undergone treatment with multiple drugs for long periods without favorable clinical response. The findings of physical examination, radiology, basal pulmonary function and post-bronchodilation and fibrobronchoscopy were normal. Organic disease was ruled out and a psychiatric evaluation was performed. Intelligence quotient was in the lower normal range and generalized anxiety order was identified, thus establishing a diagnosis of psychogenic cough. Treatment consisted of relaxation techniques and psychopedagogic support with favorable outcome. To avoid diagnostic errors and inappropriate treatment, psychogenic cough should be included in the differential diagnosis of persistent cough and hard-to-manage asthma.

Asthma↗

Impact of a model training course for private and public specialist physicians in El Salvador.

BACKGROUND: Private and non-private specialist practitioners are often considered an obstacle to the performance of the National Tuberculosis Control Programme (NTP). OBJECTIVE: To evaluate the impact of an intensive refresher course directed at specialist physicians in El Salvador, a questionnaire was sent to all course participants on their basic knowledge of tuberculosis (TB) control. RESULTS: Of 64 participants, 55 were assessed (86%); 33 were chest physicians and 22 belonged to other related specialities. The evaluation showed a considerable improvement in both groups in their ability to suspect the disease, in their tendency to avoid hospitalising patients and instead refer them to out-patient clinics, and in their adherence to the recommendations of the NTP manual (diagnostic procedures, treatment guidelines, case notification and cohort studies). Improvements were more noticeable, in all the parameters evaluated, among the non-chest physicians. CONCLUSION: The intervention model succeeded in improving the collaboration of private and non-private specialist practitioners with the NTP.

Education, Medical↗

Evolutionary stability concepts for N-species frequency-dependent interactions.

The classical static concept of an evolutionarily stable strategy (ESS) for a single species gives rise to two new notions when there are more than two species (called an N-species ESS and RL-stability). The paper relates these to the dynamic stability of monomorphic and polymorphic evolutionary systems. It is shown that RL-stability implies the global asymptotic stability of either system with or without mutations. However, the N-species ESS only implies stability of the monomorphic system.

Animals↗

Prevention in routine general practice: activity patterns and potential promoting factors.

BACKGROUND: Primary care physicians have a unique opportunity to deliver preventive services, but a desired level of involvement is not always attained. METHODS: We analyzed self-reported preventive activity in a stratified random sample of 635 primary care physicians to determine how often they deliver effective interventions for the prevention of cardiovascular diseases, cancer, and acquired immunodeficiency syndrome as well as to assess factors associated with a greater implementation of preventive activity in routine practice. RESULTS: More than 63% reported to ask about tobacco use or alcohol consumption or to check blood pressure to most of their new patients. On the other hand, only 33% asked about intravenous drug use, 14% about sexually transmitted diseases, and 6% about the number of sexual partners and less than 33% reported to have an appropriate criterion for any periodic preventive activity in routine daily practice. Correlates of high preventive activity included group practice, specific register of preventive activities, participation in the Program of Preventive Activities of the Spanish Society of Community and Family Medicine, and specific nursing consultation. CONCLUSIONS: Organizational factors could be used to improve preventive activity which is far from being an adequate component of routine general practice especially with regard to human immunodeficiency virus infection and periodic preventive activity for chronic diseases.

Adult↗

Morphometric assessment of gastric antral atrophy: comparison with visual evaluation.

AIMS: As part of a multinational effort to reach a consensus in the definition and evaluation of atrophic gastritis, we applied morphometric techniques to 22 antral biopsy specimens examined visually by 12 experienced gastrointestinal pathologists. METHODS AND RESULTS: Atrophy was defined as loss of glands. Each pathologist graded atrophy with both non-standardized and standardized approaches. Discriminant function analyses of morphometric measurements were conducted to validate and grade atrophy. Kappa statistics were used to compare the performance of each pathologist against the group mode and against the discriminant functions' grading of atrophy. Three morphometric indexes showed significant differences among categories of atrophy utilizing non-standardized as well as standardized visual atrophy grades: (i) the ratio of glandular length to total mucosal thickness; (ii) the proportion of the secretory compartment area occupied by glands; and (iii) the number of glandular cross sections per 40x microscopic field. The discriminant function analyses verified all cases classified visually as either non-atrophic, or moderately/severely atrophic; it verified as mildly atrophic 40% of the cases classified visually as mildly atrophic; and classified the remaining 60% as moderately or severely atrophic. The kappa statistics were good or excellent for the majority of pathologists. CONCLUSIONS: The evaluation of antral atrophy, simply defined as loss of glands, can be reliable and reproducible. The visual grading of atrophy as absent, moderate and severe is entirely consistent with objective morphometric observations.

Atrophy↗

Morphometric evaluation of gastric antral atrophy: improvement after cure of Helicobacter pylori infection.

OBJECTIVE: Our purpose was to find out if morphometric techniques can document long term changes in gastric antral atrophy after curing Helicobacter pylori infection with or without dietary supplementation with antioxidant micronutrients. METHODS: Study subjects were 132 adult volunteers from a Colombian region with high gastric cancer rates. Participants were randomly assigned to ascorbic acid, beta-carotene, and anti-H. pylori treatment, following a factorial design. Gastric biopsies were obtained at baseline and after 72 months of intervention. Atrophy was evaluated by a standard visual analog scale and by morphometry. RESULTS: Statistically significant changes in antral atrophy were detected with morphometric techniques after intervention in subjects who received anti-H. pylori treatment. A nonsignificant trend was also observed with visual scores. This effect was greater among those who were free of infection at the end of the trial. After accounting for the effect of anti-H. pylori treatment, no significant effect was noted for dietary supplementation with ascorbic acid and/or beta-carotene. CONCLUSIONS: We conclude that gastric atrophy improves significantly after long term control of H. pylori infection. This effect can be demonstrated both by conventional histological grading and by morphometry.

Adult↗

Lewis antigen alterations in a population at high risk of stomach cancer.

Anomalous Lewis(a) antigen and sulfomucin expression are considered as markers of progression in precursor lesions of gastric cancer. Additionally, Lewis antigen and secretor phenotype have been related to Helicobacter pylori infection and gastric epithelial damage. The two objectives of this study were to correlate Lewis antigen alterations with histochemical changes and to explore the relationship between Lewis and secretor phenotypes and gastric epithelial damage related to H. pylori infection. The study subjects were selected from a chemoprevention trial in Tachira State, Venezuela, an area with a high risk of gastric cancer. Anomalous Lewis(a) antigen expression in Lewis (a-b+) phenotype individuals was closely related to the severity of the histological lesions, especially to dysplasia and type III intestinal metaplasia lesions. A weak relationship was observed between nonsecretor individuals and more advanced lesions of IM, but this association was not statistically significant. There was no relationship between secretor phenotype and H. pylori status, atrophy, regenerative activity, erosion, or ulcer.

Adult↗

Blood-group phenotypes, sulfomucins, and Helicobacter pylori in Barrett's esophagus.

Barrett's esophagus, morphologically analogous to gastric intestinal metaplasia, often precedes the development of esophageal adenocarcinoma. In the stomach, expression of sulfomucins and aberrant Lewis(a) (Le[a]) antigen is an excellent predictor of premalignant progression, and Helicobacter pylori infection is a crucial determinant for the development of atrophy, metaplasia, and adenocarcinoma. In the esophagus, the significance of sulfomucin expression is controversial, the aberrant expression of Le(a) has not been explored, and the role of H pylori in the evolution of preneoplastic conditions is unknown. We investigated in 155 patients referred for endoscopy the association of Barrett's esophagus with expression of sulfomucins, Lewis, secretor, and ABO phenotypes, and H pylori infection. We report a subtype of intestinal metaplasia, present in all patients with esophageal adenocarcinoma, similar to gastric intestinal metaplasia of colonic type (type III or incomplete), that expresses sulfomucins and aberrant Le(a) in goblet and columnar cells. Lewis(a+b-), nonsecretor and blood group A phenotypes, were all positively associated with esophageal adenocarcinoma, suggesting a genetic susceptibility. H pylori infection was detected in 75% of patients with esophageal adenocarcinoma.

ABO Blood-Group System↗

Lewis, secretor, and ABO phenotypes, and sulfomucin expression in gastric intestinal metaplasia.

The closely interrelated Lewis, secretor, and ABO phenotypes have long been linked to the risk of peptic ulcers and gastric cancer and may modulate the interaction between Helicobacter pylori and the gastric surface epithelium. We explored the association between the expression of sulfomucins in gastric intestinal metaplasia, a known marker of preneoplastic progression, and the expression of Lewis, secretor, and ABO phenotypes, in 523 subjects from Nariño, Colombia, and 856 subjects from northern Spain. In both study populations, Lewis (a+/b-) and nonsecretor phenotypes showed a significant positive association with the expression of sulfomucins (odds ratios, 2.4 and 2.6, respectively).

ABO Blood-Group System↗

Characteristics of continuous esophageal pH-metering in infants with gastroesophageal reflux and apparent life-threatening events.

Episodes of apnea during the first year of life have been classified with the term "Apparent Life-Threatening Events" (ALTE). Gastroesophageal reflux (GER) has been accepted to be one of the factors which can favor ALTE. The aim of this work is to study the continuous 24 h gastroesophageal pH-metering (fundamentally the Reflux Index [RI] and the Area Under Curve [AUC] parameters in three different periods of time: total pH-metering, pH-metering excluding the first two post-prandial hours, and pH-metering during sleep time, for 24 infants, 14 with ALTE and 10 without it). Between these two groups (with and without ALTE) there were no significant differences in the total pH-metering concerning the RI (2 +/- 1.2 vs 5.6 +/- 7.5 p > 0.05) and concerning the AUC (24.9 +/- 14.4 vs 67.4 +/- 84 p > 0.05), but in the analysis of the sleep period, the RI (p < 0.05) and the AUC (p < 0.01) both showed significant differences in the group of infants without ALTE. These results confirm that pH-metering study during sleep is the procedure of choice for recognizing infants with ALTE.

Circadian Rhythm↗

Laparoscopy without use of the Veress needle: results in a series of 1,600 procedures.

OBJECTIVE: To describe a method of laparoscopy without use of the Veress needle and to analyze the associated complications. DESIGN: We retrospectively reviewed all 1,600 laparoscopic procedures performed in the Department of Obstetrics and Gynecology at Nitra Hospital from Aug. 23, 1989, to Jan. 31, 1994. MATERIAL AND METHODS: Our laparoscopic techniques were outlined, and our complication rate was assessed and compared with that from the literature. RESULTS: In the 1,600 procedures, 6 complications occurred (0.375%)--4 technical failures in extremely obese patients, 1 case of umbilical granuloma 2 months after the procedure, and 1 case of omental prolapse on the sixth postlaparoscopic day. CONCLUSION: Results from this series of procedures suggest that laparoscopy without use of the Veress needle is simple, safe, efficient, and easy to learn.

Female↗

[Knowledge and attitudes of practice of health workers in Bizkaia health centers toward diet and cholesterol].

OBJECTIVE: Analyze the extent to which criteria and practice of the Sanitary Personnel approximate the recommendations of the Consensus on the Control of Hypercholesterolemia in Spain, find out how extensive their dietary knowledge in and how skillful they are to interview and counsel a patient with hyperlipidemia. DESIGN: Transversal study with simple aleatory sampling using a questionnaire. PARTICIPANTS AND LOCATION: 101 physicians and 95 nurses working in Primary Health Care Teams in Bizkaia, during the monthly of June 1991; deputies for periods inferior to 3 months were excluded. MEASUREMENTS AND MAIN RESULTS: 82% of physicians (P) counselled dietetic treatment for cholesterolemic levels coinciding with those set in the Consensus and 70% demanded excessive analytical controls for hypercholesterolemic patients under treatment already normalized; 37% (P) and 12% of nurses (N) knew that the polyunsaturated/saturated fat ratio is the main dietetic factor; various errors were detected in questions relating to olive oil, unsaturated fat in fish and fibre values of legume; accurate responses between 13-54% (N) and 23-77% (P). CONCLUSIONS: The "mediterranean diet" is not sufficiently known; our ability for the dietetic interview and personalized counsel needs to be improved. In the light of the above and taking into accounted the gaps and deviations existing between our practice and the Consensus and its applications, we consider a better diffusion of the cited document is necessary among Primary Health Care Teams.

Diet↗

[Helicobacter pylori infection and duodeno-gastric reflux].

We have studied and measured the duodenogastric reflux in 11 children with chronic abdominal pain and Helicobacter pylori (HP) through 24-hours gastric pH-metric studies. All parameters evaluated: Number of reflux episodes (NR 92.87 +/- 27.66), number of reflux episodes longer than 5.0 minutes (NR > 5M 11.45 +/- 4.68), longest reflux episode (LR 67.37 +/- 45.57) and alkaline reflux area (AA 604.89 +/- 443.54) had significative differences against a normal group (40 children). We concluded that duodenogastric reflux and HP are frequent together.

Adolescent↗

[Fasciola hepatica infestation. Biopathology and new diagnostic and therapeutic aspects].

We present here 6 patients with Fasciola hepatica infection, all from rural origin, and with the risk factors of eating wild watercress. The more common symptoms were: fever (83%), abdominal pain (100%), weight loss (83%) and generalized myalgia and joint pain (67%). All patients presented with an absolute eosinophil count above 1,000 cell/mm3. The diagnosis was established in five cases by means of serologic techniques (haemagglutination) and with direct visualization of adult worms while surgery in one case. A CT abdominal scan was performed in five patients, revealing specific lesions of tissue infiltration in four of them. Praziquantel was used in four patients, achieving clinical cure in three cases. In two patients, bithionol was used, with clinical cure in both cases. We review also some newer diagnostic and therapeutic approaches to this parasitic disease.

Adult↗