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Biomedical subjects

J Marrugat

Publications and source records attributed to J Marrugat.

At least 19 recordsLinked to original sources
PubMed1997

Six-month outcome in patients with myocardial infarction initially admitted to tertiary and nontertiary hospitals. RESCATE Investigators. Recursos Empleados en el Síndrome Coronario Agudo y Tiempos de Espera.

OBJECTIVES: The aim of the present study was to ascertain whether the degree of accessibility to coronary angiography and revascularization results in differing usages or outcomes, or both, in the setting of a high coverage national health system. BACKGROUND: The selective use of coronary angiography and revascularization procedures in the management of acute myocardial infarction (MI) remains controversial. METHODS: A cohort of 1,460 consecutive patients with a first MI admitted to four referral teaching hospitals (one with tertiary facilities) were followed up for 6 months after admission. Only patients initially admitted to each of the study hospitals were retained for analysis in the original hospital's cohort. End points were 6-month mortality and readmission for reinfarction, unstable angina, heart failure or severe ventricular arrhythmia. RESULTS: Patients admitted to the tertiary hospital were more likely to undergo coronary angiography (adjusted relative risk 4.22, 95% confidence interval [CI] 3.37 to 5.45) than those admitted to the nontertiary sites (use rate: 22.1% for nontertiary care, 55.5% for tertiary care). Revascularization procedures were performed in 21.2% of patients in the tertiary hospital and in 8.3% in the nontertiary hospitals (p < 0.0001). Median delay for emergency coronary angiography was shorter in the tertiary hospital (within 1 vs. 2 days, p < 0.0001). Six-month mortality or readmission rates were similar (23.7% and 24.7% for tertiary and nontertiary care, respectively). After adjustment for comorbidity and disease severity, the relative risk of death or readmission for the tertiary hospital was 1.03 (95% CI 0.69 to 1.53) times that of the nontertiary hospitals. CONCLUSIONS: Selective use of coronary angiography and revascularization procedures may be as effective as less restricted use in the management of acute MI.

Aged↗
PubMed1997

Assessment of the appropriateness of the decision of heart transplantation in idiopathic-dilated cardiomyopathy.

One hundred thirty patients with idiopathic-dilated cardiomyopathy were referred for heart transplantation to our center and followed for 18 months. Heart transplantation was performed on 63 patients, 17 patients died before transplantation due to heart failure, and 50 patients never had transplantation. Clinical, electrocardiographic, echocardiographic, and hemodynamic data of the 50 nontransplanted survivors and the 17 patients who died were used to identify independent risk variables with discriminant analysis. Using a statistical model based on the results of discriminant analysis, each of the remaining 63 transplanted patients were predicted as being alive or dead in absence of transplantation. The discriminant analysis identified right atrial pressure, cardiac index, and the New York Heart Association functional class as the strongest predictors of 18-month outcome. The accuracy of the model in predicting survival without transplantation in the nontransplanted group of patients, based on the concordance between actual and predicted outcome, was 85% (kappa = 0.62). Subsequent application of this model to the transplanted group of patients suggested that the decision for transplantation was appropriate in 41 of the 63 patients, and could have been premature in the remaining 22 patients predicted as alive. These results suggest that two-thirds of patients receiving transplants would have died without intervention, but the decision to transplant could have been premature in the remaining patients.

Adult↗
PubMed1997

Interaction of family history of atherosclerosis with atherogenic lipid traits in men with non-coronary atherosclerosis.

Family history of atherosclerosis has been recognised as an nonmodifiable cardiovascular risk factor. Lipid levels, together with hypertension and diabetes, appear to have an inheritable component. The aim of the study was to ascertain whether lipoprotein abnormalities of 169 adult patients with non-coronary atherosclerosis were associated with a family history of atherosclerosis. Besides intermediate density lipopoprotein composition and Lp(a) levels, we focused on apo(a) and apo E phenotypes, LDL cholesterol/apo B ratio, VLDL triglyceride/HDL cholesterol ratio, and environmental factors. We found that patients with a family history of atherosclerosis had a higher prevalence of VLDL triglyceride/HDL cholesterol ratio above 1.8 (51.3% vs 34.7%) than patients without. Similarly, there was a significant inverse correlation between both considered ratios (r = -0.24, p < 0.05). The odds ratio of the presence of both abnormal ratios (4.60, 95% CI, 1.41-15.00) and low molecular weight apo(a) isoforms (3.30, 95% CI, 1.05-10.30 and family history of atherosclerosis was independent of smoking and hypertension. Apo(a) isoform size seems to be more important than Lp(a) concentrations in the family history of atherosclerosis risk determination. Subsequent analysis showed that patients with a family history of atherosclerosis had a greater-than-fourfold increased risk of having one or both abnormal ratios reflecting metabolic disturbances which probably constitute a combined trait. Family history of atherosclerosis may constitute a specific lipoprotein-related marker of atherosclerosis. Such a marker often precedes the onset of overt disease and may contribute to identifying patients with an atherogenic lipoprotein profile even in the absence of classical lipid risk factors.

Adult↗
PubMed1997

Transcranial magnetic stimulation as a prognostic tool in stroke.

Our aims were to evaluate the prognostic usefulness of magnetic motor evoked potentials (MMEPs) in ischemic stroke, to study the evolution of MMEP abnormalities and the relationships between MMEP abnormalities and infarction topography. We prospectively analyzed 50 consecutive ischemic stroke patients who were followed up to 1 year. MMEPs were recorded 1, 3, 30 and 90 days after stroke and we measured amplitudes and latencies/central motor conduction times (CMCTs) of MMEPs from hypothenar, biceps brachiallis, gastrocnemius and quadriceps. Univariate and multivariate analyses of the clinical and MMEPs data were performed. Patients with Rankin 0-3 at 1 year had had acutely MMEPs with shorter latencies and higher amplitudes than patients with Rankin 4-5 or deceased patients. Increased blood pressure correlated with increased survival, whereas increased heart rate and hyperglycemia correlated with increased mortality. The variables infarction size on second CT, age, and first day CMCT-S1 correctly classified 1 year outcome on discriminant analysis. The inclusion of MMEPs values increased the probability of correct classification from 76% to 84%. We conclude that in patients with nondisabling strokes MMEPs may have an independent value in the prediction of prognosis, increasing the accuracy of prognosis calculations made employing clinical and laboratory data. Topography of lesions should be considered when analyzing MMEP abnormalities after stroke.

Aged↗
PubMed1997

[Registries of morbimortality in cardiology: methods].

The effectiveness of diagnostic, preventive and therapeutic procedures, whose efficacy has been assessed in clinical trials, should be tested in a real treatment scenario. The procedures used in acute myocardial infarction (AMI) management can be evaluated by means of cohort studies that include all consecutive patients admitted to one or several hospitals. Such studies are called hospital registries. They are simpler to organize and cheaper than clinical trials. On the other hand, the AMI population-based registries allow the establishment of the incidence and mortality rates, as well as case-fatality as they include those patients who die before reaching hospital facilities. In both types of registries a set of variables on co-morbidity, age, sex, severity, and the utilization of procedures along with the course of the disease are systematically recorded in each patient using standard definitions to warrant the internal validity. In hospital registries, the external validity of the results will depend on whether the sample of hospitals represents the population where it was obtained. A good registry should include patients with a wide age range, allow the analysis of specific subgroups of patients such as non-Q wave or first AMI to allow for comparison with other registries. In addition, it should also permit a mid-term follow-up, respect ethical issues, receive appropriate funding and keep a multidisciplinary team involved in its design and development.

Cardiology↗
PubMed1997

Spectrum of alcohol-induced myocardial damage detected by indium-111-labeled monoclonal antimyosin antibodies.

OBJECTIVES: We sought to determine the prevalence, intensity and evolving changes of myocardial damage detected by myocardial uptake of antimyosin antibodies in patients with alcohol-induced dilated cardiomyopathy, alcohol addicts attending a detoxification unit and healthy subjects with short-term alcohol consumption. BACKGROUND: Evidence of alcohol-induced myocardial damage may be provided by myocardial uptake of indium-111-labeled monoclonal antimyosin antibodies. The spectrum of such damage in patients who are heavy drinkers (> 100 g for > 10 years), with or without cardiomyopathy, and the impact of short-term alcohol ingestion on antimyosin antibody uptake have not been adequately explored. METHODS: One hundred twenty antimyosin studies were performed in 56 patients with dilated cardiomyopathy (group I), 15 alcohol addicts attending a detoxification unit (group II) and 6 volunteers for short-term alcohol ingestion (group III). Estimation of antibody uptake was calculated through a heart/lung ratio (HLR) (normal < 1.55). RESULTS: The 56 patients in group I (54 men, 2 women; mean [+/-SD] age 46 +/- 11 years) had consumed 123 +/- 60 g/day of alcohol for 21 +/- 9 years, for a cumulative intake of 914 +/- 478 kg. Mean duration of symptoms was 46 +/- 49 months. Mean left ventricular end-diastolic diameter was 71 +/- 10 mm, and mean ejection fraction was 28 +/- 12%. No differences in New York Heart Association functional class, ventricular size or ejection fraction were noted between 28 active and 28 past consumers, except for the prevalence and intensity of antibody uptake (75% vs. 32%, p < 0.001) and HLR (1.75 +/- 0.26 vs. 1.49 +/- 0.17, p = 0.0001). In 19 patients in the active group restudied after alcohol withdrawal, antibody uptake decreased (from 1.76 +/- 0.17 to 1.55 +/- 0.19, p < 0.001), and ejection fraction improved (from 30 +/- 12% to 43 +/- 16%, (p < 0.001). No changes occurred in the 15 past consumers restudied. The 15 male patients in group II (mean age 36 +/- 4 years) had consumed 156 +/- 59 g/day for 17 +/- 5 years, for a cumulative alcohol intake of 978 +/- 537 kg, an amount similar to that in patients in group I, but antimyosin antibody uptake was detected in only 3 (20%) of 15 patients. None of six group III subjects developed antibody uptake after short-term ethanol ingestion. Despite the small sample size, the power to detect clinically relevant differences in most variables that did not reach statistical significance was amply sufficient. CONCLUSIONS: In alcohol-induced dilated cardiomyopathy, alcohol withdrawal is associated with the reduction or disappearance of myocardial damage and improvement of function. The difference in prevalence of antimyosin antibody uptake in patients with and without cardiac disease who consume similar amounts of alcohol suggests the presence of those with different myocardial susceptibilities to alcohol. Short-term ethanol ingestion in healthy subjects does not induce detectable uptake of antimyosin antibodies.

Adult↗
PubMed1996

Amount and intensity of physical activity, physical fitness, and serum lipids in men. The MARATHOM Investigators.

Physical activity improves one's lipid profile and increases physical fitness. The present study was aimed at determining the association of amount and intensity of leisure time physical activity with serum lipid profile and physical fitness. A total of 537 healthy men aged 20-60 years were recruited in a quota sampling frame for measurement of physical activity energy expenditure at two different levels. The Minnesota Leisure Time Physical Activity Questionnaire was administered. Serum lipid and lipoprotein levels were measured, and all participants were given an exercise test. Physical activities with an intensity greater than 7 kcal/minute were significantly associated (p < 0.01) with a higher level of high density lipoprotein (HDL) cholesterol and a lower atherogenic index (total cholesterol:HDL cholesterol). Independently of other confounding variables, each average 100 kcal/day expended in leisure time physical activity with an intensity greater than 7 kcal/minute during the previous year was associated with an increase of 2.09 mg/dl (0.054 mmol/liter) in HDL cholesterol and a decrease of 0.23 in atherogenic index. However, only physical activity with an intensity greater than 9 kcal/minute was associated with decreases in total cholesterol, non-HDL cholesterol, and log(triglycerides). Better physical fitness was associated with physical activities of intensities above 5 kcal/minute. There is a threshold in the intensity of exercise associated with serum lipid profile (7 kcal/minute) and physical fitness (5 kcal/minute). Above the former threshold, the relation between amount of physical activity and lipid levels is linear for total cholesterol, HDL cholesterol, non-HDL cholesterol, and atherogenic index and is logarithmic for triglycerides.

Adult↗
PubMed1996

A clinical trial on the prevention of catheter-related sepsis using a new hub model.

BACKGROUND: Catheter hub contamination is being increasingly recognized as a source of catheter-related sepsis. The authors have investigated the efficacy of a new hub design in preventing endoluminal catheter contamination and catheter-related sepsis arising at the hub. METHODS: Adult surgical and intensive care patients requiring a subclavian catheter for at least 1 week were randomly assigned to receive catheters with standard connectors (control group, n=73) or equipped with a new hub model (new hub group, n=78). Skin, catheter tip, and hub cultures were performed at the time the catheter was withdrawn because therapy was terminated or because of suspicion of sepsis, in which case peripheral blood cultures were taken. RESULTS: Of the 151 patients included, 15 (10%) developed catheter-related sepsis. Catheters were more often withdrawn because suspicion of infection in the control group (42 vs. 19%, p<0.005). Catheter sepsis rate was higher in the control group (16 vs. 4%, p<0.01) because of the low rate of catheter sepsis arising at the hub observed in the new hub group (1 vs. 11%, p<0.01). The prevalence of culture-positive catheter hubs without associated bacteremia (colonization) was higher in the control group (18 vs. 5%, P<0.03). CONCLUSIONS: A new catheter hub has proved to be useful in preventing endoluminal bacterial colonization and catheter-related sepsis in subclavian lines inserted for a mean of 2 weeks.

Adult↗
PubMed1996

Effect of malnutrition after acute stroke on clinical outcome.

BACKGROUND AND PURPOSE: Malnutrition has received little attention in acute stroke, although it represents a risk of decreased immunity and nosocomial infections. Our objectives were to determine the prevalence of malnutrition after 1 week of hospitalization in acute stroke and to establish its relation to the stress response and neurological outcome. METHODS: The study included 104 patients with an acute stroke of less than 24 hours' duration. Nutritional parameters (triceps skinfold thickness, midarm muscle circumference, serum albumin, and calorimetry) were evaluated at admission and after 1 week. Stress response (free urinary cortisol) was measured daily during the first week. Neurological deficit was evaluated by the Canadian Stroke Scale. Clinical outcome was estimated by the Barthel Index 1 month after the acute stroke. Patients received an oral standard diet or polymeric enteral nutrition when they had swallowing difficulties. RESULTS: Protein-energy malnutrition was observed in 16.3% of patients at inclusion and in 26.4% after the first week, with a significant decrease in fat (P = .002) and visceral protein compartments (P = .049). Malnourished patients showed higher stress reaction and increased frequency of infections and bedsores in comparison with the appropriately nourished group. Multiple logistic regression analysis showed that malnutrition after 1 week (odds ratio, 3.5; 95% confidence interval, 1.2 to 10.2) and elevated free urinary cortisol (odds ratio, 3.3; confidence interval, 1.05 to 10.2) increased the risk of poor outcome (death or Barthel Index < or = 50 on the 30th day of follow-up) independently of age and nutritional status at admission. CONCLUSIONS: Our findings suggest that protein-energy malnutrition after acute stroke is a risk factor for poor outcome. Early appropriate enteral caloric feeding did not prevent malnutrition during the first week of hospitalization.

Acute Disease↗
PubMed1996

Interrelationship of triglyceride-rich lipoproteins, serum lipoprotein (a) concentration and apolipoprotein(a) size.

At present, the biochemical mechanisms underlying lipoprotein(a) (Lp(a)) metabolism are not fully understood. We analysed sera from 202 patients with atherosclerotic disease and 109 healthy subjects as a control group to investigate the possible relationship between triglyceride-rich lipoproteins (TRL) and serum lipoprotein(a) levels. To assess the influence of apolipoprotein (apo) (a) isoforms on the Lp(a)-TRL association, the apo(a) phenotypes of 177 patients and 95 controls were included in the analysis. Patients with atherosclerotic disease showed triglyceride levels almost within the normal range. There was no significant correlation between serum Lp(a) levels and triglyceride concentrations, or between Lp(a) and TRL levels in either group. When a subset of subjects from each group with serum triglycerides above 1.7 mmol l-1 was considered, a significant negative correlation between lipid concentration of very low density lipoproteins (VLDL) and serum Lp(a) levels was found only in patients. Control subjects with triglyceride levels under or over 1.7 mmol l-1 showed similar median Lp(a) levels (0.06 gl-1), in contrast to atherosclerotic patients, in whom median Lp(a) concentration was higher in the subset with serum triglycerides under 1.7 mmol l-1 than in those with triglyceride concentration above this value (0.16 vs. 0.13 gl-1). When patients with triglyceride concentrations above 1.7 mmol l-1 were classified into quartiles according to VLDL lipid concentration, subjects with the highest quartiles showed the lowest Lp(a) median levels. Despite the dependence of the Lp(a) concentration on apo(a) size isoforms, we found no effect of apo(a) genetic polymorphism on triglyceride levels or on TRL concentrations. We conclude that the variation in TRL metabolism may constitute a source of variation in serum Lp(a) concentrations that is independent of the genetically determined apo(a) molecule size.

Aged↗
PubMed1996

[Basis for a hospital registry of acute myocardial infarction in Spain. The PRIAMO study. Project of a Hospital Registry of Acute Myocardial Infarction].

BACKGROUND AND OBJECTIVES: Information on the management of myocardial infarction in Spain in scarce. PRIAMHO (Proyecto de Registro de Infarto Agudo de Miocardio Hospitalario) study is aimed at developing standardized methods to allow the registration of characteristics and management of patients discharged with a diagnosis of myocardial infarction. Methods and results of the pilot study are presented. METHODS: In the present collaborative study with one-year follow-up, all patients diagnosed with myocardial infarction discharged from 33 Spanish hospitals are registered for one year including their demographic, clinical and outcome characteristics, as well as details on their management when admitted to a coronary care unit. Standardized definitions of diagnosis and measurements are used. Confidentiality of patients' identity and anonymous participation of each center are also warranted. RESULTS: The 33 participant coronary care units, covering some 10,000,000 people, admitted on average 83.9% of myocardial infarction patients of their hospital. In 16 participating centers there is a laboratory of hemodynamics and in 11 coronary surgery. During the pilot study, 606 patients were discharged from the participating coronary care units where the case-fatality, rate was 10.3%. While 19.8% of patients developed left heart failure, 44.1% received thrombolytic therapy. The delay between onset of symptoms and first monitoring was approximately 6 hours, and thereafter admission to the coronary unit about 3 hours. CONCLUSION: PRIAMHO study will allow to establish of the fundamentals for developing a nation-wide myocardial infarction register and will provide an accurate perspective of the characteristics and management of this disease in Spain.

Aged↗
PubMed1995

Antibodies to human immunodeficiency virus (HIV-1) in autoimmune diseases: primary Sjögren's syndrome, systemic lupus erythematosus, rheumatoid arthritis and autoimmune thyroid diseases.

The aetiology of autoimmune diseases remains unknown. The relationship between virus, and more recently retrovirus, has been suggested with this group of diseases. Immunoblotting is a useful method for determining the presence of proteins coded by different retrovirus genes. Since the prevalence of these types of proteins in patients with primary Sjögren's syndrome (SS), systemic lupus erythematosus (SLE), rheumatoid arthritis (RA) and autoimmune thyroid diseases has not been fully established, the aim of this work was to determine the prevalence of antibodies to immunodeficiency human virus type 1 (HIV-1) proteins in these diseases and their possible relationship with the presence of anti-nuclear, anti-DNA, anti-SSA (Ro) and anti-SSB (La) autoantibodies. Antibodies to human immunodeficiency virus (HIV-1) were studied in a group of 341 patients with autoimmune diseases (77 SS, 98 SLE, 75 RA, 91 autoimmune thyroid diseases) and 126 blood donors as a control group. A Western blot was used to detect antibodies to HIV-1, and a double polymerase chain reaction (PCR) using nested primers in the gag and pol gene of HIV-1. Antinuclear antibodies, anti-DNA, anti-SSA (Ro) and anti-SSB (La) were determined by enzyme-linked immunosorbent assays. At least one band was shown on immunoblotting in 26% of patients with autoimmune diseases and 35% of controls. The presence of antibodies to p55 or p68 proteins in patients with SS or SLE proved to be the only statistically significant difference between the other autoimmune diseases studied and the control group. These antibodies were not associated with autoantibodies ANA, DNA, SSA (Ro) or SSB (La).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Improvement in survival after myocardial infarction between 1978-85 and 1986-88 in the REGICOR study. (Registre GIroní del COR) registry.

Aspirin, intravenous nitrates and fibrinolysis were being used by 1986 in Girona, Spain. These combined factors should be reflected in myocardial infarction patients' outcome. We assessed changes in 28-day and 3-year survival after a first myocardial infarction between 1978-85 and 1986-88 in the REGICOR (Registre GIroní del COR) registry. This included 1216 consecutive patients with a first transmural myocardial infarction (834 in 1978-85 and 372 in 1986-88). Their 28-day and 3-year mortality rates were 14.6% and 8.8% respectively. Although patients admitted in the second period were more frequently hypertensive and diabetic, a history of angina was less common in patients admitted between 1978 and 1985. After adjusting for diabetes, hypertension, age, and sex, the relative risk of 28-day mortality of those admitted in the second period was 0.65 (95% confidence interval 0.42-0.99). The lower severity, as measured by Killip class of patients in the second period, was the main (confounding) variable responsible for this protective effect. Three-year mortality of those surviving 28 days in 1978-85 (8.3%) did not differ from 1986-88 (8.3%). In the second study period hospitalized patients with myocardial infarction in Girona, Spain showed a better 28-day survival. It is possible that therapeutic and diagnostic refinements, together with other factors not controlled in the present study, have resulted in such an improvement. However, 3-year mortality remained unmodified among those surviving 28 days.

Adult↗
PubMed1995

Bone growth and modeling changes induced by periosteal stripping in the rat.

In this study, the changes in longitudinal bone growth and metaphyseal modeling induced by middiaphyseal periosteal stripping in the rat femur were analyzed by means of histomorphometrical techniques. One hundred forty-four male 30-day-old Sprague-Dawley albino rats distributed in 4 groups of 36 were studied: a control group, a sham group, a group with middiaphyseal right femoral periosteal stripping, and a group with a polyethylene ring wrapped around the stripped zone. The animals were euthanized at 1, 2, or 4 weeks from the start of the experiment, after double tetracycline labeling. A statistically significant, albeit small, longitudinal overgrowth of stripped femurs was observed after a latency period of 2 to 4 weeks. The metaphyseal diameters were greater in stripped femurs than nonstripped femurs. This finding was associated with a lower osteoclastic index in the external metaphyseal surface and with a lower bone formation rate in the internal surface of the metaphyseal cortex. These latter findings have not been reported previously in the literature and may support the role of the periosteum in controlling metaphyseal modeling.

Animals↗
PubMed1995

Effect of smoking on sudden and premature death.

BACKGROUND: Smoking has been related to coronary heart disease, and, in men, to sudden death. The results of a case-control study designed to assess the relationship between smoking and all causes of sudden and premature death are reported. METHODS: A questionnaire on the previous history and causes of death of all people buried in the Municipal Cemetery of Valencia (1986-1987) was administered to the relatives of the deceased. Among 4718 deaths, 284 victims of sudden death were identified, and 495 people who had not died suddenly were randomly sampled as controls. RESULTS: The proportion of smokers among the women studied was extremely low in contrast to 58.9% of men in the sudden death study group and 59.2% of men in the non-sudden death study group who smoked. Smokers died on average 10 years younger than non-smokers in the sudden-death group (63.3 +/- 12.3 and 73.3 +/- 11.0 years respectively; P < 0.001), and 8 years earlier in the non-sudden death group (68.5 +/- 13.3 and 76.8 +/- 13.2 years, respectively; P < 0.001). A logistic regression model showed that smokers had an adjusted relative risk of 0.81 for sudden death compared with non-smokers (95% confidence interval [CI]: 0.45-1.46). Smokers 65 years of age or under had a 2.7 times greater risk (95% CI: 1.49-5.04) of premature death than non-smokers. Similar results were found in patients from the coronary- and cardiac-death subgroups. CONCLUSIONS: Smoking is an independent risk factor for premature death but not for sudden death.

Case-Control Studies↗