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J Ribas

Publications and source records attributed to J Ribas.

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

[Analysis of the cost-effectiveness relationship in the empirical treatment in patients with infections of the lower respiratory tract acquired in the community].

BACKGROUND: Cost of treatment of community-acquired infections in Spain is an important factor in overall health expenditures. The aim of this study was to assess the direct health costs related with the treatment of patients with community-acquired pneumonia (CAP) and acute exacerbations of chronic bronchitis (AECB) due to infection, using different antibiotic options, and to identify main cost drivers. METHODS: A basic decision analysis model was developed, including probabilities estimation derived from the literature review, supplemented when needed by the opinion of a panel of 8 Spanish physicians (Delphi technique). Four groups of antibiotics were included (macrolides, beta-lactam, fluoroquinolones and cephalosporins) in two different groups: patients with CAP without hospital admission criteria and patients with AECB due to respiratory infection. The analytic horizon and the perspective used were those of the Spanish National Health Service. Direct cost were assessed (drugs, outpatient visits, hospital admissions, diagnostic tests). Indirect cost were not included in the model. Final costs uses as main outcome measure the average cost per patient treated. All results were calculated following a fold-back technique. Sensitivity analysis were included allowing for variations in several clinically relevant parameters. RESULTS: 1. Patients with CAP: Hospital admissions, directly related to the effectiveness rate of initial empirical antibiotic therapy, were the main cost driver (50%-70%). Acquisition costs of initial antibiotic therapy only account for 2%-13% of total costs. 2. Patients with AECB: Outpatient visits are the main cost driver for these group of patients (49% of total costs). Hospital admission costs are also an important cost driver (40%-51% of total costs). Acquisition costs of initial antibiotic therapy account for 4%-28% of total costs. Clinical effectiveness of first antibiotic option is the main variable regarding the cost-effectiveness rate. CONCLUSION: The model here presented showed that acquisition costs of first empirical antibiotic therapy are only a small proportion of total costs related with the management of community acquired lower respiratory tract infections in Spain. The clinical effectiveness rate of the first antibiotic used is the main variable which determines the final average cost per patient cured. For patients with lower respiratory tract infections the therapeutic option with a better cost-effectiveness ratio must be chosen, in order to minimize the risk of therapeutic failure after first line therapy, and should not be selected only by its lower acquisition costs.

Anti-Bacterial Agents↗
PubMed1999

Isosorbide-5-mononitrate in the treatment of pulmonary hypertension associated with portal hypertension.

Pulmonary hypertension is uncommonly associated with portal hypertension. The current approach for the management of pulmonary hypertension involves the use of vasodilators in patients who show vascular responsiveness during an acute challenge. Since the association of portal hypertension with pulmonary hypertension is very seldomly presented, its optimal therapy has not been defined. Moreover, calcium-channel blockers, which are usually used in pulmonary hypertension treatment, may exert a deleterious effect on portal hypertension. Therefore, the search for drugs that may be active under both conditions has important clinical implications. This report presents the case of a patient with portal hypertension-associated pulmonary artery hypertension that was effectively treated with isosorbide-5-mononitrate (Is-5-Mn). The patient had severe portal hypertension (hepatic venous pressure gradient=14.5 mmHg) and pulmonary hypertension (mean pulmonary artery pressure (PAP)=50 mmHg). Acute administration of prostacyclin and nitric oxide elicited a significant reduction in both PAP and pulmonary vascular resistance (PVR), an effect that was also achieved with Is-5-Mn. The patient was treated with 40 mg Is-5-Mn twice daily and a haemodynamic study performed 6 months later showed that the reduction in both PAP and PVR persisted.

Female↗
PubMed1999

Effects of inhaled furosemide on platelet-activating factor challenge in mild asthma.

Furosemide (Fur) may have an anti-inflammatory effect on airways in patients with asthma although its intrinsic mechanism remains elusive. Platelet-activating factor (PAF) is a potent proinflammatory mediator that induces systemic and respiratory effects in normal control subjects and asthmatics. The aim of this study was to assess whether pretreatment with nebulized Fur (40 mg) was able to modulate PAF-induced systemic and respiratory effects in asthma. Eleven patients were studied (mean+/-sem 22+/-0.8 yrs) with mild asthma (forced expiratory volume in one second, 95+/-4%) in a randomized, double-blind, placebo-controlled, cross-over fashion, one week apart. PAF challenge (18 microg) was carried out 15 min after administration of Fur or placebo. Peripheral blood neutrophils, respiratory system resistance, and arterial blood gases were measured at baseline, and 5, 15 and 45 min after PAF; urinary cysteinyl leukotriene E4 (uLTE4) was also measured, at baseline and 120 min after PAF challenge. Although Fur did not alter PAF-induced systemic and respiratory effects, it did partially inhibit (63%; p<0.04) the increments of uLTE4 levels shown after PAF inhalation. It is concluded that furosemide is not effective in protecting against platelet-activating factor challenge in patients with asthma despite its potential inhibition of leukotriene synthesis. These findings reinforce the view that the pulmonary effects of platelet-activating factor are mediated through different pathways.

Administration, Inhalation↗
PubMed1999

Perioperative antibiotic prophylaxis in Spanish hospitals: results of a questionnaire survey. Hospital Pharmacy Antimicrobial Prophylaxis Study Group.

A questionnaire survey was sent to a random sample of the Spanish network of National Health System public acute-care hospitals. Of responding institutions (representing 25% of Spanish hospital beds), nearly 75% had active surveillance programs for the prevention and control of surgical-site infections (SSIs), but only 20% performed postdischarge surveillance. Overall, perioperative antibiotic prophylaxis (PAP) was used in 84% of all surgical procedures. For 77% of procedures, there were written guidelines for the choice and use of PAP. Cefazolin was the most commonly used antibiotic (38%). Duration of PAP was shorter than 24 hours in 75% of procedures, and only a single dose was given in 52% of procedures. PAP was commonly used in breast (52%) and inguinal hernia repair (69%) procedures, as well as in laparoscopic abdominal surgery (86%). In summary, the use of PAP in Spanish hospitals is adequate, but improvements can be made in the frequency of prolonged PAP and in the use of broad-spectrum antibiotics. Surveillance systems for SSI, including postdischarge follow-up, also should be improved.

Antibiotic Prophylaxis↗
PubMed1998

[Pancoast's syndrome secondary to neck metastasis with normal radiography of the thorax].

Pancoast's syndrome is characterized by pain in the shoulders and upper extremities, Horner's syndrome, bone loss and hand muscle atrophy. Bronchogenic carcinoma is the most common cause, although other neoplasms or lung infection are occasionally responsible. An apical mass on the chest film can be seen in over 90% of cases, although apical pleural thickening is sometimes the only radiographic finding. We describe a patient whose clinical picture was highly suggestive of Pancoast's syndrome but whose chest film was normal. Magnetic resonance imaging disclosed a cervical mass adjacent to the brachial plexus that proved to be cervical metastasis from an unknown primary tumor. We emphasize the need to consider the possibility of a metastatic cervical tumor compromising the brachial plexus in patients with a normal chest X-ray but clinical signs highly suggestive of Pancoast's syndrome.

Adult↗
PubMed1998

Effect of nitric oxide synthesis inhibition with nebulized L-NAME on ventilation-perfusion distributions in bronchial asthma.

Patients with clinically stable asthma may show ventilation-perfusion (V'A/Q') mismatch. Nitric oxide (NO), a potent endogenous vasodilator, is increased in exhaled air of asthmatics. Such an increased NO production may be detrimental for optimal V'A/Q' balance owing to the potential inhibition of hypoxic pulmonary vasoconstriction. This study was undertaken to investigate the relationship between the concentration of NO in exhaled air and the degree of gas-exchange impairment and to assess the effect of nebulized N(G)-nitro-L-arginine methyl ester (L-NAME), a competitive inhibitor of NO synthesis, on gas exchange in patients with asthma. Twelve patients (four females and eight males, aged 31+/-5 yrs) with clinically stable asthma (forced expiratory volume in one second (FEV1) 80+/-5%) not treated with glucocorticoids and increased exhaled NO (58+/-9 parts per billion (ppb)) were studied. Exhaled NO, respiratory system resistance (Rrs), arterial blood gases and V'A/Q' distributions were measured before and 30, 60, 90 and 120 min after placebo or L-NAME (10(-1) M) nebulization; in eight patients pulmonary haemodynamics were also measured. At baseline no relationships between exhaled NO and gas-exchange measurements were shown. Nebulized L-NAME induced a significant decrease in exhaled NO (p< 0.001), which was maximal at 90 min (-55+/-5%). However, after L-NAME no changes in Rrs, arterial oxygen tension, the alveolar-arterial pressure difference in oxygen or V'A/Q' distributions were shown and nebulized L-NAME did not modify pulmonary artery pressure. In conclusion, the degree of gas-exchange impairment in stable asthma is not related to nitric oxide concentration in exhaled air and nitric oxide synthesis inhibition with N(G)-nitro-L-arginine methyl ester does not alter gas exchange or pulmonary haemodynamics, such that ventilation-perfusion disturbances do not appear to be related to an increased synthesis of nitric oxide in the airways.

Administration, Inhalation↗
PubMed1998

Invasive exercise testing in the evaluation of patients at high-risk for lung resection.

The aim of this study was to investigate whether invasive exercise testing with gas exchange and pulmonary haemodynamic measurements could contribute to the preoperative assessment of patients with lung cancer at a high-risk for lung resection. Sixty-five patients scheduled for thoracotomy (aged 66+/-8 yrs (mean+/-SD), 64 males, forced expiratory volume in one second (FEV1) 54+/-13% predicted) were studied prospectively. High risk was defined on the basis of predicted postpneumonectomy (PPN) FEV1 and/or carbon monoxide diffusing capacity of the lung (DL,CO) <40% pred. Arterial blood gas measurements were performed in all patients at rest and during exercise. In 46 patients, pulmonary haemodynamic measurements were also performed at rest and during exercise. Predicted postoperative (PPO) values for FEV1 and DL,CO were calculated according to quantitative lung scanning and the amount of resected parenchyma. There were four postoperative deaths (6.2% mortality rate) and postoperative cardiorespiratory complications developed in 31 (47.7%) patients. Patients with respiratory complications only differed from patients without or with minimal (arrhythmia) complications in FEV1,PPO. Peak O2 uptake and haemodynamic variables were similar in both groups. The four patients who died had a lower FEV1,PPO, a lower DL,CO,PPO and a greater decrease in arterial oxygen tension during exercise, compared with the remaining patients. In conclusion, the forced expiratory volume in one second, together with the extent of parenchymal resection and perfusion of the affected lung, are useful parameters to identify patients at greatest risk of postoperative complications among those at a high-risk for lung resection. In these patients, pulmonary haemodynamic measurements appear to have no discriminatory value, whereas gas exchange measurements during exercise may help to identify patients with higher mortality risk.

Adult↗
PubMed1997

[Comparative study of an expert system application in the prescription of medications].

BACKGROUND: The aim of this study was to evaluate the impact of a expert drug system implementation on the drug prescription habits and on drug cost in an university hospital. MATERIAL AND METHODS: During a 3 months period, the drug prescriptions to patients admitted to the Internal medicine, lung, gastroenterology and hepatology units, have been evaluated through the expert drug system (Medisource). This expert drug system functions in according to patients characteristics such as age, weight, height, sex, renal function and liver function. It recommends the correct dose, detects interactions and adverse effects and makes suggestions in pregnancy and lactation. It also offers alternative drugs with their cost. During the study period physicians were unaware of the investigation being performed. RESULTS: 836 patients (63.9 +/- 16.5 years) with an average hospital stay length of 11.6 +/- 6.7 days were studied. The most common diagnoses were: lung obstructive chronic disease, cirrhosis, gastrointestinal hemorrhage and cancer. The total amount of drug prescribed was 6,308. The expert system detected 458 overdosages and 33 underdosages, mainly in antibiotics and antiulcer drugs, and 1,722 interactions. The drug costs reduction that could be obtained following the expert system recommendations was 4.5% in antibiotic drugs and 23% in antiulcer drugs. CONCLUSION: The frequency of drug overdosage and underdosage in patients admitted in an university hospital is relatively high. The expert systems available for drug decisions could solve this problem.

Aged↗
PubMed1997

[Direct pharmaceutical costs, diagnostic related groups and CD4 cell count in hospitalized HIV-infected patients].

BACKGROUND: To estimate the direct pharmaceutical costs of the HIV-infected patients admitted in the HCP, the variability and the relation between CD4 cell count. PATIENTS AND METHODS: We collected for each patient admitted to Department of infectious Diseases between 1/1/93 to 12/12/94 the direct pharmaceutical cost for GRD and diagnosis discharge. Also we collected the lymphocyte CD4 cell count. RESULTS: The number of patients observed was 877 and the total pharmaceutical cost was 65,756,751 pts., 24,900,827 pts. were spent in antibiotic drugs and 22,225,273 pts. in antiviral drugs (non anti-HIV included). 568 patient had CD4 cell count on admission. 75% of them had a CD4 cell count less than 50 x 10(4)/l. The variability of the pharmaceutical cost estimated in the GRD 489, 490 and diagnosis discharge was higher than 150%. There was not lineal correlation between the total costs and the CD4 cell count. The mean direct pharmaceutical costs in patients with CD4 cell count less than 60 x 10(6)/l was greater than in the others. CONCLUSIONS: Antibiotic and antiviral drugs accounted for the 72% of global pharmaceutical cost in HIV patients admitted. The variability observed in the GRD 489 and 490 was high. The direct pharmaceutical costs were conditioned by the lymphocyte CD4 cell count because this parameter determine the type of infections disease that these patients suffered.

AIDS-Related Opportunistic Infections↗
PubMed1997

Cytosolic Ca2+ gradients in pancreatic islet-cells stimulated by glucose and carbachol.

Digital image analysis was employed to resolve the spatial differences in distribution of cytosolic free Ca2+ concentrations ([Ca2+]i) in mouse pancreatic islet-cells stimulated with glucose and carbachol. Using Indo-1 loaded mouse islet-cells, we have demonstrated that glucose induces steep spatial gradients of [Ca2+]i in isolated mouse islet-cells. Furthermore, the largest [Ca2+]i increase was always spatially restricted to a region just beneath the plasma membrane. Low concentrations of carbachol (0.6 microM) induced steep spatial gradients of [Ca2+]i which originated from the center of the cells. However, 10 microM carbachol increased [Ca2+]i to high levels collapsing the [Ca2+]i gradients in the center of the cells. Different patterns of [Ca2+]i oscillations were observed between dissociated pancreatic islet-cells and mouse pancreatic islets when challenged with 11 mM glucose. Under these conditions we could identify cells within the islet which oscillate with the same pattern as the whole islet. We postulate that "initiators" of insulin release, as glucose, induce greater [Ca2+]i increases at exocytotic sites than those induced by "potentiators", as carbachol.

Animals↗
PubMed1997

[Adverse effects associated with antimalarial chemoprophylaxis].

BACKGROUND: To evaluate the frequency and type of adverse drug reactions associated to the antimalarial chemoprophylaxis advised to travellers visiting endemic areas. SUBJECTS AND METHODS: We included the travellers who from july 1992 to june 1994 came to the Travellers Advise Department and made short-term travels to areas with malarial infection risk. The adverse drug reactions were reported by the travellers through a questionnaire handed at the consulting room. The pharmacological regimens advised were: a) chloroquine base 5 mg/kg/week. b) chloroquine base 5 mg/kg/week + proguanil 100 mg/day if weight less than 55 kg and 200 mg/day if weight more than 55 kg. c) mefloquine 250 mg/week. RESULTS: We evaluated 1,054 questionnaires for the study. The 18.4% of the travellers reported adverse drug reactions. The 12.4% of the travellers who were on chloroquine, the 17.2% of those who were on chloroquine + proguanil and the 20.3% from mefloquine group presented adverse drug reactions (differences without significance). Comparing the regimens studied, we observed that neuropsychiatric reactions were more frequent in the mefloquine group (p < 0.01), the gastrointestinal reactions were less common in the chloroquine group (p = 0.04) and the transitory eye disorders were more frequent in the chloroquine + proguanil group (p = 0.01). In the mefloquine group the travellers with adverse drug reactions had a significantly lower weight than those who did not present them (p < 0.01). CONCLUSIONS: The adverse drug reactions reported agree with the toxicologic profile described in the literature about these drugs. Mefloquine presents an outstanding neuropsychiatric toxicity and is worse tolerated in low weight patients.

Adolescent↗
PubMed1997

[Analysis of 90 cases of pleural tuberculosis in relation to adenosine deaminase levels].

BACKGROUND: To analyze the adenosine deaminase (ADA) pleural levels and the possibility of a typical pattern of tuberculous pleuritis (TP) in relation to these values. PATIENTS AND METHODS: We analyzed 90 consecutive cases of TP dividend into two groups on the basis of the pleural ADA measurements: group 1 (less than 43 U/I) and group 2 (equal or higher than 43 U/I). We compared: age, sex, tuberculous risk factors, clinic onset and duration, PPD, chest roentgenogram, biochemical (LDH, glucose and proteins) and cytological examination of the pleural fluid, microbiologic studies on sputum, pleural fluid and biopsies, histologic findings of the biopsies, evolution and sequelae after the treatment. RESULTS: 36 patients in the group 1 (40%) and 54 in the group 2 (60%) (p = 0.01). All the parameters were similar in both groups excluding LDH pleural levels, that were higher in group 2. In 20 cases of the group 1, we obtained a second analysis of pleural ADA and we observed in 11 cases (55%) an ADA value above 43 U/I. CONCLUSIONS: We confirmed that ADA pleural level is increased in the majority of our patients with a low initial sensibility of 60%, that can increase with a second determination (72%). ADA activity below 43 U/I cannot exclude the tuberculous aetiology of an effusion and can persist negative in other analyses. The results suggest a response of different chronology without any relation to initial ADA pleural level.

Adenosine Deaminase↗
PubMed1997

[Comparative study of acute and chronic forms of pleural tuberculosis].

To analyze whether a characteristic pattern distinguishes acute forms (symptoms starting no more than one week earlier) and subacute or chronic forms (symptoms lasting more than one week) of pleural tuberculosis (PT) in our practice. Retrospective analysis of 102 cases of PT diagnosed between 1986 and 1992, comparing the findings of case histories, imaging, pleural biochemistry and cytology, microbiology of sputum, pleural biopsy and fluid, anatomy and pathology studies of the biopsy specimens, course of disease, response to treatment and sequelae after one year and a half. Thirty-two patients (31.4%) had acute PT and 70 (68.6%) had chronic forms. LDH levels and the percentage of pleural nuclear polymorphism were higher in acute cases, while the concurrence of systemic involvement and lymphocytic predominance was more often seen in chronic cases. Other data analyzed were similar in both groups. No specific clinical or X-ray profiles or differences in course of disease and response to treatment distinguishes between acute and chronic forms of PT after 7 days. Only LDH levels and cytology results differentiated acute forms and, occasionally, such cases were indistinguishable from pneumonia-like effusion.

Acute Disease↗
PubMed1997

Pancoast's syndrome due to chronic pneumonia by Pasteurella multocida.

Infectious causes of Pancoast's syndrome are extremely rare. We describe the case of a patient with Pancoast's syndrome due to chronic pneumonia resulting from Pasteurella multocida. The patient was not immunosuppressed and had had no contact with animals. The diagnosis was made by transthoracic needle aspiration and institution of therapy with cefuroxime-axetil resulted in resolution of his symptoms.

Adult↗
PubMed1996

[Acute lipoid pneumonia. Report of 2 cases].

Lipoid pneumonia is a chronic infiltrative pulmonary process secondary to continued aspiration of exogenous lipids (laxatives and nasal drops). On occasions, an acute form of lipoid pneumonia which may lead to respiratory failure may be observed coinciding with accidental massive aspirations of lipidic material. Two cases of acute lipoid pneumonia secondary to paraffin aspiration in << fire eaters >> are presented.

Accidents, Occupational↗
PubMed1996

[Efficacy and tolerance of the treatment of tuberculosis in the aged].

We analyzed 55 confirmed cases of tuberculosis in patients over 65, a sample that amounted to 9% of all patients seen in our practice over a period of 5 years. Mean age was 72.4 and the male/female ratio was 4/1. The most frequently associated diseases were tobacco addiction (49%), chronic obstructive pulmonary disease (33%), alcoholism (25%) and prior diagnosis of tuberculosis (20%). Lung involvement was the most common clinical presentation (76%), followed by pleural (9%) and skeletal (7%) involvement. The clinical picture was non specific, with 13% remaining asymptomatic. Cough was the most frequent symptom (45%) and unilateral apical fibrosis with ulceration was the most frequent radiological finding. Pleural discharge and cavitation were demonstrated in 14 and 22%, respectively. Scarring was visible on X-rays in 44%. The tuberculin test was positive in 88% of the cases in which it was performed. Mean delay in diagnosis was 3.4 months; 62% were diagnosed by sputum test, 11% by culture, and 27% histology. In 4% death was directly caused by tuberculosis. Three patients withdrew from treatment, in one case treatment failed, and there was one relapse detected at follow-up. We observed adverse side effects in 33%, and found no statistically significant differences between the 2 therapeutic protocols used (2 months RHS/7 months RH and 2 months RHZS/4 months RH). The incidence of tuberculosis among the elderly is low in our practice and the entity behaves much as it does in the rest of the adult population. Both the efficacy and tolerance of treatment can be considered optimal.

Adult↗