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Biomedical subjects

J García

Publications and source records attributed to J García.

At least 343 records · Page 19Linked to original sources
PubMedDate not supplied

[Invasive pneumococcal disease in children in the region of Murcia (Spain)].

OBJECTIVE: Because of the availability of a conjugate pneumococcal vaccine, the incidence and characteristics of invasive pneumococcal disease in children in the region of Murcia should be determined. This would provide information that could be useful for properly establishing the indications for vaccination. METHODS: A retrospective search was conducted for cases of invasive Streptococcus pneumoniae in children aged less 15 years old treated in hospitals in Murcia from 1991-2000. The data sources were the databases of the microbiology services, the Minimum Data Set, the Pediatric Admissions Register and the EDO Register. RESULTS: The incidence rate for the period 1996-2000 was 18.25 per 105 children per year for children aged under 1 year in the case of invasive disease (10.6 for meningitis), 13.6 for those under 2 years for invasive disease (6 for meningitis), 8.9 for those under 5 years (1.35 for meningitis) and 3.7 for those under 15 years (1.3 for meningitis). Twenty-eight percent of the patients presented risk factors. Complications occurred in 35.2% and sequelae occurred in 5%. The mortality rate was 11.8%. The prevalent serogroups were 19, 6, 18, 5, 14 and 23. CONCLUSIONS: The high percentage of patients with risk factors for invasive pneumococcal disease suggests the need to implement vaccination programs aimed at risk groups. Although the incidence of invasive pneumococcal disease in the region of Murcia differs from that in other areas, the incidence of meningitis is similar to that reported by other studies. Because of the severity of the disease, cost-effectiveness studies to evaluate the possible incorporation of the vaccine in the vaccination calendar are justified.

Adolescent↗
PubMedDate not supplied

[Smoking prevention in the school: results of a 3-year program].

Tobacco use poses one of the greatest health problems at school. Its prevention through health education should be assumed up by all members of the school community and health personnel (especially family and respiratory physicians). We designed an anti-tobacco program lasting three years aimed at all the students of the 6th, 7th and 8th grades at school as well as those in the pre-university years that was implemented in a rural area. This study reports the results of the attitudes of the 610 students (256 boys and 354 girls, between 11 and 20 years old) collected at the end of the program. 59.4% of the boys and 44.1% of the girls reported having smoked on some occasion. The mean age at the time of the first contact with tobacco was 11.8 +/- 2.4 years, this being significantly different between the boys and the girls. The main reasons for starting to smoke tobacco were quoted as peer pressure (57.1%) and curiosity (55.5%). That their parents smoked was only adduced as a reason by 29.5% of the students. Knowledge of the harmful effects of tobacco was limited and only 57% related tobacco smoking to lung cancer and only 41% to coronary pathology. At the end of the program 13.6% of the students involved smoked. 93.9% of those who quit smoking related this event to the program. Of those still smoking, 63.6% said they would like to quit. This justifies the need to reinforce the knowledge that will allow them to switch attitudes and stop smoking. Intervention programs in school populations have proved to be useful in the struggle to decrease smoking among school children. If an adolescent can avoid smoking it is likely that s/he will not smoke in adulthood. It is necessary to further develop this type of anti-tobacco program as reflected in this paper.

Adolescent↗
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bcl-2 Expression and apoptosis in primary and metastatic breast carcinomas.

OBJECTIVES: To evaluate the role of bcl-2 and apoptotic index in the progression from primary to metastatic breast carcinoma and their influence on prognosis. METHODS: bcl-2 expression was examined by immunohistochemistry and apoptotic index by in situ end-labelling in 116 surgical breast carcinomas and lymph node metastases from 50 patients. RESULTS: bcl-2 was observed in 69 cases (59.4%) of primitive carcinomas and 26 cases (65%) of metastatic breast carcinomas and there was agreement of bcl-2 expression between primary and metastatic sites except in 3 cases. bcl-2 expression was significantly associated with several favourable prognostic features, such as small tumour size (p = 0.03) and oestrogen and progesterone-receptor positivity (p < 0.01 and p < 0.001, respectively). A high apoptotic index was significantly associated with a number of poor prognostic factors, including poorly differentiated carcinomas, large tumour size, high Ki67 expression and high mitotic count (p < 0.001 in all cases). The mean apoptotic index was higher in lymph node metastasis than in primary carcinomas (1.19 vs. 0.69, p < 0.01). A low bcl-2 expression and a high apoptotic index were significantly associated with short-relapse free survival rates (p = 0.02 and p < 0.01, respectively), but only apoptotic extent provided independent prognostic information by multivariate analysis. CONCLUSIONS: The evaluation of bcl-2 expression and extent of apoptosis may provide useful prognostic information on breast cancer patients; however while increased apoptosis is strongly associated with the progression from primary carcinomas to lymph node metastases, bcl-2 does not seem to play a significant role in this process.

Adult↗
PubMedDate not supplied

Effect of intrarenal adenosine on urinary excretion of prostaglandins and leukotrienes in the anesthesized dog.

Adenosine is a renal vasoconstrictor that plays an important role in mediating renal adaptive responses to decreases in renal perfusion pressure. It is known that adenosine acts on the metabolism of arachidonic acid, but the direct repercussions of adenosine in the production of renal prostaglandins and leukotrienes have not been studied. This study was undertaken to evaluate the effect of the intrarenal infusion of adenosine upon the urinary elimination of arachidonic acid derivatives. Samples of urine were collected with lysine acetylsalicylate and determination of prostaglandins (PGs) and leukotrienes (LTs) was performed by radioimmunoassay of samples previously separated by HPLC. The infusion of adenosine decreases the urinary excretion of 6-keto-PGF1 alpha and TxB2 significantly. There was no significant change in urinary excretion of PGE2 while LTB4 and LTC4 showed a tendency to increase. These results suggest that a fall in the synthesis of PGI2 along with an increase in LTC4, which is a constrictor of mesangial cells, could be responsible for the renal vasoconstriction phase of adenosine. Therefore, it was concluded that adenosine vasoconstriction is mediated through the inhibition of the cyclo-oxygenase pathway, diminishing the synthesis of PG vasodilators.

6-Ketoprostaglandin F1 alpha↗
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Model-based estimation of cardiovascular repolarization features: ischaemia detection and PTCA monitoring.

The ST-T segment of the surface ECG reflects cardiac repolarization, and is quite sensitive to a number of pathological conditions, particularly ischaemia. ST-T changes generally affect the entire waveshape, and are inadequately characterized by single features such as depression of the ST segment at one particular point. Metrics which represent overall waveshape should provide more sensitive indicators of ST-T wave abnormalities, particularly when they are subtle, intermittent or periodic. This study discusses a Karhunen-Loève transform (KLT) technique for the analysis of the ST-T waveform. The KL technique was used to analyse the ST-T complexes in the ESC ST-T database. KL coefficients were plotted as a function of time, and were effective in detection of transient ischaemic episodes. Twenty per cent of the records showed bursts of periodic ischaemia suggesting local vascular instability. A comparison between kl and ST depression series has shown the KL technique as more appropriate to the study of ST-T complex variations. Using the kl series, an ischaemia detector has been developed based on a resampled, filtered, and differentiated KL series. This technique demonstrates a sensitivity of 65% and a specificity of 54%. These low values can be due to shifts of the electrical axis which are detected as ischaemic changes, real ischaemic episodes that were not annotated with the protocol used at the European ST-T database, or erroneous detections. An increase in sensitivity can be obtained at the expense of a decrease in the positive predictive value and thus becomes a useful technique for previous scanning of the ECG record and subsequent review by the expert. The technique has also been used to monitor patients during a PTCA process, demonstrating that this technique allows us to monitor PTCA-induced ischaemia. A detailed analysis has shown that in some cases a repetitive oscillatory behaviour appears, lasting for a period of around 20 s, and highly related to the oscillatory behaviour of the HR. In other cases, transient changes in KL series with salves behaviour associated with the injection of contrast are shown on the ST-T waveform. We conclude that the KL-based analysis of the ST-T segment is a robust and sensitive technique, with considerable advantages over single feature measures in characterizing the subtle waveform changes which may be of importance in clinical risk detection.

Angioplasty, Balloon, Coronary↗
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[Levels of testosterone-estradiol-binding globulin TeBG and of testosterone in pregnancy with relation to the sex of the foetus (author's transl)].

A practical and economic method for the quantification of testosterone-estradiol-binding globulin TeBG is described. The procedure premits the differentiation without overlap of the TeBP levels in males, non-pregnant females and during pregnancy. Mean titles were 1/5, 1/93 and 1/360 respectively. During pregnancy, we found high levels of TeBG and increased plasma testosterone, with mean values of 143.4 nanograms/100 ml. We have found no significant differences in TeBG levels, or in maternal blood testosterone levels in relation to fetal sex; however, plasma testosterone levels were significantly different among new born of different sex, with mean values of 96.25 nanograms per cent for males and 78.21 nanograms per cent for females.

Estradiol↗
PubMedDate not supplied

[The recognition of mental disease in primary health care and its determining factors].

AIMS: It is known that recognition of mental illness by the General Practitioner (GP) is low. The GP usually identify less than a half of these cases. Our aim has been to study the prevalence of mental disorders in Primary Care, and to analyse the influence of several variables over the identification of mental illness by the GP. METHODS: Transversal study in four Primary Care centres in the north of Spain. We studied 823 patients attended with a < > in primary care practices. Patients were evaluated with the GHQ-28, Belloc questionnaire, and data regarding diagnosis and treatment provided by the GP, in addition of additional information from medical records. RESULTS: The prevalence of mental illness according the GHQ-28 was 33%, being higher in women (38%) than in men (24%). Mental illness diagnosed by the GP was the 14,1% of cases. The rate of patients with mental disorders (diagnosed by the GHQ) recognised by the GP was the 29%. In a logistic regression, relevant factors affecting recognition were i) presentation with physical symptoms, ii) clinical severity (measured by GHQ), and, iii) employment (only for older patients). CONCLUSIONS: < > can explain the low rate of identification of mental illness by the GP.

Adolescent↗
PubMedDate not supplied

[Deinstitutionalization and psychiatric reform in Spain].

The transformation of psychiatric care which has been carried out in Spain since the 1980s, under the name of < >, had produced as it most significant achievements: i) the development of a new organizational structure for mental health care, ii) the integration of psychiatric patients in the general health care system, iii) the creation of an extensive community network of mental health centers, and iv) the adoption by the general public of more positive attitudes towards mental illness and its treatment and the passing of legislative measures aimed at improving the civil rights of these patients. However, the application of the Psychiatric Reform has followed an uneven course in Spain as a whole, with marked differences between the different autonomous communities. The main deficiency has been in the development of intermediate community services and programs to rehabilitate and resettle patients in the community. With regard to deinstitutionalization, the results have also been insufficient and it is still possible to observe a strong tendency, within the system, to maintain the old mental hospitals for both long-term and short-term illness care. Finally, the analysis of the Spanish experience has revealed that, i) many of the criticisms leveled at deinstitutionalization are not aimed at its < > but stem from its inadequate implementation, and ii) it is wrong to equate deinstitutionalization and psychiatric reform with closure of psychiatric hospitals, without the awareness that this process is far more complex.

Deinstitutionalization↗
PubMedDate not supplied

[A review of the epidemiology of multiple sclerosis in Mexico].

OBJECTIVE: To review the epidemiological information on multiple sclerosis in Mexico. DEVELOPMENT AND CONCLUSIONS: The results of the few epidemiological studies on multiple sclerosis show a prevalence of 1.5/100,000 inhabitants, a figure which is not in concordance with studies carried out by institutions, which indicates an increase in the frequency of new cases. This information is not necessarily due to a true increase in prevalence. Possibly this increase is related to improved methodology for clinical and paraclinical diagnosis, especially the use of magnetic resonance. There is a need for descriptive and analytical epidemiological studies to obtain precise data on this. At present, the Mexican Group for the study of Multiple Sclerosis and The Mexican Association for the study of Multiple Sclerosis are using a questionnaire designed and validated for Mexico in order to determine the clinical characteristics and the prevalence of multiple sclerosis. The results will be available in the near future to improve knowledge regarding the epidemiology of this disorder and its economic impact on the Mexican health systems.

Humans↗
PubMedDate not supplied

[Efficiency of dialysis with albumin in the treatment of patients with advanced hepatic insufficiency: initial experience with the MARS system in Spain].

During liver failure there is an accumulation of toxic substances secondary to the loss of liver function. In order to eliminate these substances various extracorporeal depuration therapies have been employed. Recently, we have used a new treatment, MARS (Molecular Adsorbent Recirculating System), in 3 patients diagnosed with severe liver failure. This system consists of an albumin rich (20%) dialysate circuit, with two areas of depuration. In one area, the albumin dialysate is in contact with blood through a high-flux albumin coated membrane, where albumin bound substances are eliminated. In the other area, the albumin dialysate is in contact with a standard bicarbonate dialysate through a low-flux membrane, which permits the elimination of water soluble substances. The albumin of the circuit is continuously regenerated through charcoal and ion exchanger filters. In order to determine those liver failure patients suitable to receive MARS therapy we established several inclusion criteria. All patients underwent a complete clinical and biochemical evaluation before and after each treatment. All of them showed an improvement of their clinical (attenuation of pruritus and encephalopathy) and biochemical (decrease of bilirubin levels) parameters. During the period of treatment 2 patients developed an increase in plasma creatinine levels together with a decrease of urinary volume. There were no hemodynamic or technical complications during the treatment. These promising results deserve further controlled studies large enough to permit confirmation.

Adsorption↗
PubMedDate not supplied

Pacing requirements after orthotopic heart transplantation: incidence and related factors.

To assess the incidence of severe bradyarrhythmia and pacing requirements after orthotopic heart transplantation, as well as the possible causal mechanisms, we have reviewed our experience on 52 consecutive transplant patients. The overall incidence of bradyarrhythmia requiring pacing for at least 24 hours after transplantation was 27% (14 patients). The conditions of three of them required pacing for less than 1 week; the conditions of the other 11 patients (21%) required pacing for more than 1 week. Normal sinus rhythm resumed in all but four patients within 3 weeks; a permanent pacemaker was implanted in these four patients (7.6% of all 52 patients and 28% of patients requiring temporary pacing). Late complete heart block associated with acute rejection developed in two patients whose conditions required implantation of a permanent pacemaker. The age and sex of the recipient and donor were similar for patients with or without bradyarrhythmia. The percentage of patients with or without bradyarrhythmias taking amiodarone before transplantation (57% and 46%, respectively), total ischemic time (133 +/- 33 and 123 +/- 37 minutes, respectively), and cardiopulmonary bypass time (117 +/- 17 and 132 +/- 65 minutes, respectively) were not significantly different for either group of patients. The initial temperature of cardioplegic solution for organ storage and the preimplantation myocardial temperature were, however, significantly lower in patients whose conditions required pacing immediately after transplantation than in those whose conditions did not require pacing (5.3 +/- 1.7 degrees C versus 6.5 +/- 1.5 degrees C, p less than 0.05, and 3.9 +/- 1.6 degrees C versus 5.7 +/- 2.6 degrees C, p less than 0.01, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[Comparative study of psychiatric disorders in general traumatism and brain injured patients].

INTRODUCTION: This study evaluates the presentation of different psychiatric pathologies secondary to traumatic injuries; assessing the presentation frequency and how it correlates with whether it is a brain injury (TBI) or one in a different corporal area. METHODS: The study group consisted of 249 patients, 122 with TBI and 127 with injuries from different body areas. The patients conditions were evaluated at baseline and at 6 and 12 months after the traumatic episode. Psychiatric diagnosis was made using a structured clinical interview and DSM-IV criteria. RESULTS: Depressive and anxiety disorders were observed in frequencies similar to previous reports; without significant differences between TBI and non-TBI groups. The organic change of personality was significantly more frequent among patients with TBI than among the non-TBI with apathy features. There was a significant decrease in quality of life one year after the traumatism in both groups. CONCLUSIONS: Psychiatric disease is a frequent complication of injured patients; and it is associated with deterioration of general health and quality of life. TBI patients have more probability of developing an organic change of personality.

Brain Injuries↗