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J Toro

Publications and source records attributed to J Toro.

At least 19 recordsLinked to original sources
PubMed2005

Body image, risk factors for eating disorders and sociocultural influences in Spanish adolescents.

The aim was to study differences between male and female adolescents as regards body dissatisfaction, some risk factors for eating disorders, and exposure to social influences that create ideal body figures among these populations. A questionnaire comprising 40 items was administered to 240 male adolescents at 12 public and private schools in Barcelona. Twenty-nine of the questions were the same as those in another study administered to a sample of 675 female adolescents attending similar schools in the same geographical area. The other 11 questions were specifically for males. The differences between boys and girls were highly significant on almost all the items. Girls' scores were significantly higher (p = 0.000) in the following areas: dieting and exercising in order to be thin; feelings of anxiety on seeing or showing the body in public; tendency to focus on the bodies of others and on the amount of food they eat; the belief that thin people are more popular. In addition, the girls were significantly more vulnerable to potentially dangerous social influences. For the most part, males sought a heavier, more muscular body. Though a minority of males also feared being overweight, one out of four ate more than normal to gain weight and two out of three exercised to develop their muscles. The same proportion reported envying the build of certain actors. In adolescence, the ideal body figures of the sexes vary widely. This divergence reflects a greater risk of eating disorders in girls, who are also far more exposed to social situations that cause body dissatisfaction and shape risk attitudes and behaviors.

Adolescent↗
PubMed2005

Alendronate in kidney transplant patients: a single-center experience.

INTRODUCTION: Osteoporosis following a renal transplant is an important cause of morbidity. Several studies have demonstrated the efficiency of diphosphonates for the prevention and treatment of osteoporosis. METHODS: We evaluated the effect of alendronate treatment on bone mineral density (BMD) in patients with osteoporosis (lumbar spine and/or hip t-scores < or = -2.5). Two study groups were established: group A (n = 13), patients treated orally with vitamin D, calcium, and alendronate (70 mg/week) and group B (n = 12) patients receiving only vitamin D and calcium. The immunosuppression regimen mostly used was steroids and cyclosporine. BMD was determined at the lumbar spine and hip using a Hologic 4500 QDR densitometer at the start of treatment and after 1 year. RESULTS: The study groups showed no significant differences in age, sex, menopause, or transplant time. Group A received a mean of 1.80 +/- 1.3 microg vitamin D/week and 1.3 +/- 2.1 g calcium/d, compared to 1.1 +/- 1 microg and 1.25 +/- 2.3 g, respectively for group B (NS). After a mean of 411.15 +/- 107.75 days of treatment, a significant increase in BMD at the femoral neck was recorded in group A, but not at the level of the spine (+5.57% +/- 3.5%, P < .05 and -0.42% +/- 12%, NS, respectively). No significant changes were observed in group B (-1.45% +/- 8% femoral neck and +1.69% +/- 3.5% hip, NS). Dyspepsia was reported by 7% of patients. CONCLUSIONS: In this preliminary analysis, alendronate produced, improvements are so far limited to an increased BMD in the hip.

Alendronate↗
PubMed2005

Plasmapheresis for the prophylaxis and treatment of recurrent focal segmental glomerulosclerosis following renal transplant.

We evaluated 10 patients with primary focal segmental glomerulosclerosis (FSGS) treated with plasmapheresis (PS) following renal transplantation. Three patients lost their first graft due to FSGS recurrence. In seven patients, PS was indicated as treatment for probable recurrence defined as the onset of proteinuria above 1 g/24 hours. In the remaining three patients, treatment was started in the first week posttransplant as prophylaxis against recurrence. The PS protocol was 17 sessions with the exchange of 2.5 L of plasma for 5% albumin over 10 to 12 weeks. Losartan (25 to 100 mg/d) was given to most patients at the end of PS treatment. The mean follow-up time after PS was 10 months. All patients currently have a functioning graft. A full response to treatment, defined as persistently reduced proteinuria to less than 500 mg/24 hours or the lack of recurrence in prophylactic treatment, was achieved in six patients. Three patients showed a partial decrease in proteinuria (to less than 1 g/24 hours). One patient failed to respond and still has nephrotic range proteinuria. No adverse effects of PS were recorded. A prompt start of PS combined with the use of losartan yields good results in the prophylaxis and treatment of recurrent FSGS following renal transplant in terms of quickly reduced proteinuria. Given the natural course of FSGS, a longer follow-up is needed to estimate the impact of PS on graft survival.

Adult↗
PubMed2005

Eating disorders in Spanish female athletes.

The objective of the study was to determine the prevalence of eating disorders and risk factors for their development in female athletes. Two hundred and eighty-three elite sportswomen, competing in 20 different sports, were administered the EAT, the CETCA (the Eating Disorders Assessment Questionnaire, based on DSM-III-R diagnostic criteria), and two other inventories which evaluated 1) the possible influence on eating disorders of exposure of the body in public and 2) pressure from coaches regarding eating habits, weight, physical appearance and performance. More than 11% of subjects had scores above the cut-off point (>30) on the EAT questionnaire, a proportion similar to that found in a general female population in Spain. On the basis of the CETCA score, AN was putatively diagnosed in 2.5% of the sample, and BN in 20.1%. Though some of these cases may have been EDNOS (eating disorders not otherwise specified), the proportion of athletes suffering from some kind of eating disorder was five times higher than in the general population (22.6% vs. 4.1%). No differences were found between the sportswomen and the general population in terms of specific risk behaviours and attitudes, but a substantial subgroup of athletes presented two or more of these risk behaviours. Exposure of the body in public seems to be a risk factor for eating disorders in general, and pressure from coaches seems to be a risk factor for bulimia.

Attitude↗
PubMed2005

Readiness to recover in adolescent anorexia nervosa: prediction of hospital admission.

OBJECTIVES: To determine if motivation to change in anorexia nervosa during treatment is a predictor of hospitalisation in adolescent patients. METHOD: The Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ), the Eating Disorders Inventory-2 (EDI-2) and the Beck Depression Inventory (BDI) were administered to a group of 70 anorexia nervosa patients (mean age 15.6 years). They were all receiving treatment at a specialised Eating Disorder Unit and were at different points in the treatment programme. Admission during 6-9 month follow-up was recorded in 63 of these patients who had been admitted to the Unit. The other 7 patients were contacted by phone to determine if they had been hospitalised in another unit during the follow-up period. RESULTS: Patients who needed hospital admission during follow-up had higher mean scores at first evaluation on some of the EDI-2 scales and on the BDI, lower ANSOCQ scores and were more likely to have been outpatients at first evaluation. In the logistic regression analysis a low ANSOCQ score and being an outpatient at first evaluation were shown to be independent predictors of hospitalisation during follow-up. CONCLUSIONS: Low motivation to change, depressive symptomatology and some EDI-2 scales are related to the necessity of hospital admission in adolescent patients with anorexia nervosa.

Adolescent↗
PubMed2004

Validity of a measure of readiness to recover in Spanish adolescent patients with anorexia nervosa.

The objective of the present study was to evaluate readiness to recover in adolescent patients with anorexia nervosa with a Spanish version of the Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ). Three measures-the ANSOCQ, the Eating Disorders Inventory-2 (EDI-2) and the Beck Depression Inventory (BDI)-were administered to a group of 70 anorexia nervosa patients (mean age = 15.6 yrs) who were receiving treatment at a specialized eating disorder unit and had reached different stages of the treatment programme. The ANSOCQ was administered again after one week in 42 patients to evaluate test-retest reliability. The ANSOCQ demonstrated good internal consistency (Cronbach's alpha =.94) and one week test-retest reliability (r =.90). Negative, significant correlations were found between the ANSOCQ and several scales on the EDI-2 (r between -.50 and -.72) and the BDI (r = -.68). The Spanish version of the ANSOCQ seems a reliable instrument to evaluate readiness to recover in adolescents with anorexia nervosa.

Adolescent↗
PubMed2004

[Interstitial pneumonitis associated with sirolimus administration in a renal transplantation patient: a clinical case].

Sirolimus is an immunosuppressive drug which has proved its effectivity to reduce the incidence of acute rejection in renal transplantation receptors. As this drug lacks nephrotoxic effects, its simultaneous use with other anticalcineurinic drugs allows the use of reduced doses. Thrombocytopenia and hyperlipidemia are the best known side-effects of sirolimus administration. Alterations in hepatic biochemistry results are also common. Some instances of interstitial pneumonitis associated to its use have been recently reported. In this paper we present a clinical case related to this rare but already confirmed adverse side-effect, which apart from the other more common nosologies occurring in immunosuppressed patients, should be taken into account in the differential diagnosis of interstitial pneumonitis in patients who are being administered this drug.

Aged↗
PubMed2003

Cue exposure in the treatment of resistant bulimia nervosa.

OBJECTIVE: It was hypothesized that binge eating (bulimia nervosa [BN]) may be caused by the anticipatory and immediate anxiety associated with certain types of food. Consequently, an extinction schedule should reduce binge eating. METHODS: Cue exposure was carried out with 6 bulimic women who had responded poorly or not at all to the usual pharmacologic or cognitive-behavioral treatments. RESULTS: Binge eating and vomiting were almost totally suppressed in the 6 patients. Symptom suppression was maintained at two follow-ups, one at 4-20 months and another at 2.5-3 years. DISCUSSION: Cue exposure may be effective with BN that is resistant to conventional treatments. The anxiety associated with food plays an important role in provoking and/or maintaining binge eating. Motivation to change is likely to be an important mediator.

Adolescent↗
PubMed2003

Hepatitis C and the incidence of diabetes mellitus after renal transplant: influence of new immunosuppression protocols.

BACKGROUND: Hepatitis C has been associated with an increased incidence of diabetes mellitus (DM) following renal transplantation (RT). METHODS: Patients who underwent RT between 1985 and 2001 were excluded if they showed DM prior to RT, graft survival of less than 90 days, and unknown anti-HCV status (n=15). Two groups (G1 and G2) were distinguished according to the immunosuppressive regimen: G1 (transplanted 1985-1996) received steroids, azathioprine, and cyclosporine (n=330), whereas G2 (1997-2000) received new drugs in several combinations (MMF in 87% and/or tacrolimus in 35% [n=240]). Patients with HCV antibodies pre- and/or post-RT were considered HCV-positive. Post-RT DM requiring prolonged treatment with oral antidiabetics or insulin (>1 month) was assessed using Kaplan-Meier curves and Cox analysis. RESULTS: G2 patients were significantly older, had a greater body mass index (BMI), and suffered significantly less from acute rejection episodes during the first year than G1 patients. Furthermore, fewer required maintenance steroids. HCV-positivity was more common in G1 than in G2 (n=96, 29.1% vs n=27, 11.3%). Six G2 patients were successfully treated with interferon pre-RT, achieving negative PCR-HCV status (maintained post-RT). DM incidence at 4 years was similar in G1 and G2 (8.8% and 8.2%). G1 HCV-positive patients showed a greater risk of developing DM than HCV-negative patients (28.0% vs 6.2% at 10 years; P=001). In G1, multivariate analysis showed that age, BMI, and HCV-positivity were significant risk factors predicting DM (relative risk, 5.7; 95% confidence interval 2.7-12). In G2 patients, HCV was not associated with an increased risk of DM; in the multivariate analysis only age appeared to be a risk factor. CONCLUSIONS: The reported relationship between hepatitis C and post-RT DM was not observed among patients receiving new immunosuppressive treatments. Confirmation of this finding requires extended follow up. The reduced use of steroids and effective pre-RT use of interferon may also be responsible for the benefit.

Adult↗
PubMed2003

Outcome of kidney transplant in chronic hepatitis C virus patients: effect of pretransplantation interferon-alpha2b monotherapy.

Hepatitis C virus (HCV) infection represents an important problem for hemodialysis patients especially following renal transplantation. We assessed the outcome of HCV-positive patients undergoing renal transplantation after treatment during the pretransplant period with alpha-interferon 2b (alpha-IFN2b). Data from all HCV-infected patients (n=38) undergoing renal transplantation from a cadaveric donor between January 1997 and June 2002 were retrospectively reviewed. Viral clearance was achieved in 7 of 13 patients receiving alpha-IFN2b monotherapy during the pretransplant period. Controls were HCV-negative renal transplantation recipients operated during the same period (n=273). HCV-positive compared to HCV-negative patients showed no differences in age, gender, underlying disease, donor type, or immunosuppressive regimen, but there were significant differences (P<.001) in the mean (+/-SD) time on dialysis (155+/-70 versus 43+/-47 months), retransplant incidence (26% versus 5%), immunization rate as assessed by panel reactive antibodies (PRA) peak >50% (55% versus 18%), or 1-year survival of recipients (88% versus 97%) and of grafts (76% versus 89%). In contrast, all seven HCV RNA-negative patients who were before transplantation survived to the end of follow up with functioning grafts in six subjects and remained with normal liver function and clearance of HCV RNA. We conclude that kidney transplantation in HCV-positive compared with HCV-negative patients shows lower recipient and graft survival rates, possibly due to the higher incidence of risk factors, such as duration of hemodialysis, higher retransplantation rate, or hyperimmunization. Responders to pretransplantation IFN therapy show an excellent prognosis of liver function and overall outcome close to HCV-negative renal transplant recipients.

Antiviral Agents↗
PubMed2003

Osteoarticular pain and bone mineral density in renal transplantation.

INTRODUCTION: The reduction of bone mineral density (BMD) levels is an important complication after renal transplantation. The prevalence of nontraumatic lesions may reach 22%. Patients with lower osseous mass suffer the highest number of lesions. OBJECTIVE: Evaluate BMD in patients over 30-years old who have undergone renal transplantation more than 1 year prior, who attend a medical facility complaining of osteoarticular pain and were prescribed rest or any analgesia. PATIENTS AND METHODS: One hundred twenty-three patients who received a renal transplant from a cadaveric donor from 1980 through 2000 were included in the present study to measure BMD levels in the hips and the vertebral column using a densitometer (Hologic 4500 QDR). Our study complied with WHO recommendations, which define normal values as a T score >-1 SD osteopenia as a (T score between <-1 and >-2.5 SD), and osteoporosis as a T score <-2.5 SD. Patients were divided into three groups according to gender and hormonal status. The following clinical and analytic data were collected: age, gender, race, age at onset of menopause, diabetes mellitus (DM), weight, size, retransplantation, period of evolution after transplantation, and parathormone (PTH), creatinine, and renal clearance values. RESULTS: There were 51 men (41.1%) included. Forty postmenopausal (32.5%) and premenopausal women (26%) were also included. In all patients we observed a correlation between a reduction in BMD values and age, duration post-transplantation, and body weight (P<.05). Reduced BMD levels in premenopausal women were related with lower body weight, (P<.05) and elevated PTH levels (P<.024). CONCLUSIONS: We observed that patients who had undergone transplantation displayed a moderately higher risk of suffering a fracture. Such risk increased in the case of women with more frequent fractures in the vertebral column. In 23.8% of patients reporting osseous pain, there was no reduction in BMD levels. Therefore, we must look for other disorder, responsible for the pain and prescribe adequate treatment.

Adult↗
PubMed2002

Schistosomiasis mansoni in areas of low transmission: epidemiological characterization of Venezuelan foci.

Severe schistosomiasis is a rare event in Venezuela nowadays, after a successful national campaign by the Schistosomiasis Control Program. Unfortunately, this program has practically disappeared, and snail surveillance in field is not a priority, anymore. Thus, schistosomiasis has become a neglected disease in this country. However, surveys in different populations from the endemic area have shown particular epidemiological features described herein. In five communities we evaluated 2,175 persons and searched for the presence of Biomphalaria glabrata snails. Some markers were used for classifying schistosomiasis foci: mean age of the persons with Schistosoma mansoni eggs in the stools, serological tests, presence of B. glabrata snails, and intensity of infection. Places without B. glabrata snails and with few schistosomiasis cases were defined as "past transmission sites"; a site with abundant snails but few cases was defined as "potential risk"; "new transmission" foci were characterized by the presence of infected snails and young people passing eggs in the stools. A "re-emergent" focus has shared these last features, showing in addition a place where schistosomiasis had been reported before. Recent evidences of active transmission with the increasing dispersion of B. glabrata snails, point out the necessity for the re-establishment of the Schistosomiasis Control Program in Venezuela.

Adolescent↗
PubMed2002

[Cost of maintenance immunosuppressive drugs in kidney transplantation].

METHOD: We calculated the cost of maintenance immunosuppression (ISM) in 405 kidney transplant patients under treatment for more than one year, classifying them according to the combination of drugs used and whether the ISM continued to be the same as initially indicated (primary ISM), or a later adaptation. Basic clinical data were also acquired on the through levels of drugs and the use and cost of the associated medication. RESULTS: The mean doses in mg/kg/day and the trough levels in ng/ml were: cyclosporin (Cs), 2.7 +/- 0.9 and 123 +/- 5; tacrolimus (T), 0.09 +/- 0.06 y 7.3 +/- 2.9; Mycophenolate mofetil (MMF), 21.6 +/- 6.8 and 3.3 +/- 2.4. The proportion of patients with doses of steroids (EST) below 5 mg/day among patients treated with MMF was 60% in association with Cs and 73% with T. The cost related to EST and azathioprine (AZA) is very low; the mean cost per patient and day for Cs, T and MMF, was 7.08, 12.59 and 9.53 euros, respectively. The annual cost per patient depending on treatment was, in euros: EST + AZA, 204; Cs or without AZA and/or EST: 2,555; T with or without AZA and/or EST: 4,616; Cs plus MMF with/without EST: 6,136; T plus MMF with/without EST: 7,212. In cases of primary ISM, the difference between the two treatments with MMF drops so, low that its loses statistical significance (7,206 and 6,443 euros). This is because the dose of MMF is 50% higher in cases treated with Cs, even though there is no difference in the trough level of MMF. The use of hypolipidemic agents (with a mean annual cost of 451 euros) is much lower in treatments with T in comparison with Cs (13.8% vs 41.4%, p < 0.001). No significant differences could be established between T and Cs regarding the use of hypotensive agents and the frequency of postransplant insulin dependent diabetes. CONCLUSIONS: The treatment of ISM with T is more expensive than Cs based treatment but the difference is reduced in combination with MMF because of the use of lower doses of MMF in the association of T with MMF. The considerable economic impact of ISM would justify the provision of greater resources to the rationalisation of the treatments currently being applied.

Costs and Cost Analysis↗
PubMed2001

[Anorexia nervosa].

Explore the source record for details and available documents.

Anorexia Nervosa↗
PubMed2001

Cutaneous lymphomatoid granulomatosis: correlation of clinical and biologic features.

Lymphomatoid granulomatosis (LYG) is a rare angiocentric and angiodestructive Epstein-Barr virus-associated B-cell lymphoproliferative disorder (EBV-BLPD), varying widely from an indolent process to an aggressive large cell lymphoma. The skin is the extrapulmonary organ most commonly involved in LYG. We studied 32 skin lesions from 20 patients with known pulmonary LYG, using immunohistochemistry, in situ hybridization for EBV, and polymerase chain reaction for the presence of antigen receptor gene rearrangements (IgH and TCR) to better define both the clinicopathologic spectrum and pathogenesis of the cutaneous lesions. We describe two distinct patterns of cutaneous involvement. Multiple erythematous dermal papules and/or subcutaneous nodules, with or without ulceration, were present in 17 patients (85%). These lesions demonstrate a marked angiocentric lymphohistiocytic infiltrate, composed predominantly of CD4-positive T-cells, with a high propensity for involving the subcutaneous tissues, and exhibiting angiodestruction, necrosis, and cytologic atypia. EBV-positive B-cells were detected in the nodules from five patients; clonal immunoglobulin heavy chain gene (IgH) rearrangements were detected by polymerase chain reaction in two patients. Multiple indurated, erythematous to white plaques were present in three patients (15%). The plaque lesions were negative for EBV and clonal IgH gene rearrangements in all cases studied. The clinical course of overall disease was variable, ranging from spontaneous regression without treatment (1 of 13; 7%), resolution with chemo/immunomodulatory therapy (8 of 13; 62%), and progression (4 of 13; 31%). The clinical and histopathologic features of cutaneous LYG are extremely diverse. However, the majority (85%) of the cutaneous lesions mirrors to some extent LYG in the lung, although EBV+ cells are less frequently identified. This subset of cases shows the histopathologic triad of angiodestruction with associated necrosis, panniculitis, and in some cases atypical lymphoid cells. The commonality of the histologic features in this group suggests a common pathophysiologic basis, possibly mediated by cytokines and chemokines induced by EBV. A small percentage of the lesions (15%) presented as indurated and atrophic plaques, and EBV was not identified in the small number of cases studied. The relationship of the plaque-like lesions to LYG remains uncertain. Whereas some cases of LYG regress spontaneously, most require therapy.

Adolescent↗
PubMed2001

Adolescent anorexia nervosa: the catch-up effect in bone mineral density after recovery.

OBJECTIVE: To determine whether bone mineral density (BMD) loss can be reversed in adolescent anorexic patients. METHOD: A prospective study with 108 anorexia nervosa patients (DSM-IV) from 12 to 17 years of age at the Eating Disorders Unit in the Hospital Clinic of Barcelona (Spain). They were first evaluated by dual-energy x-ray absorptiometry in lumbar spine and femoral neck consecutively from 1997 until 1999 and reexamined after 6 to 30 months. Results were compared with normative values of bone mass. RESULTS: Patients with poor outcome (n = 44) had a bone mass loss. Patients with good short-term outcome were divided in two groups. The group with normal BMD at first evaluation (n = 41) had a bone mass gain per year of 3.0% at lumbar spine and 0.5% at femoral neck. The group with low BMD at first evaluation (n = 23) had an increase per year of 9.1% at lumbar spine and 4.5% at femoral neck. In a multiple linear regression analysis with the variables body mass index, age, months with menstruation, and BMD zscore at first evaluation, the only predictor of BMD increase was the first z score both at the lumbar spine (coefficient R = 0.64; p < .001) and at the femoral neck (coefficient R = 0.5; p < .001). CONCLUSIONS: There is a catch-up effect in adolescent patients with low BMD but good short-term outcome.

Adolescent↗
PubMed2001

[Survival of grafts in the first 100 renal transplants at the Carlos van Buren Hospital].

BACKGROUND: Renal transplant is the best therapeutic alternative for chronic renal failure, although it is not exempt of risks. AIM: To report the survival of renal transplant recipients and grafts and the main complications at a public hospital in Chile. PATIENTS AND METHODS: This is a non experimental, open historical cohort study, with reposition of the first 100 transplants in 94 patients, performed at the Carlos van Buren Hospital between 1984 and 1998. Seventy grafts came from cadaveric donors and 30 from live donors. As immunosuppressive therapy, prednisone + azathioprine was used in 48 transplants and the same regimen plus cyclosporine in 52. RESULTS: Mean age of recipients was 36 +/- 23 years old. Ten years actuarial survival of patients was 80.5% in transplants from cadaveric donors and 86% in transplants from live donors. Ten years graft survival was 57.5% in transplants from cadaveric donors and 42% in transplants from live donors. The period in which the transplant was performed (first or second half of the observation period), type of donor, HLA B-DR compatibility and sensitization (% PRA) had no effect on survival. Twenty five subjects lost their graft, 12 due to acute steroid resistant rejection, 10 due to chronic graft nephropathy and three due to renal artery thrombosis. Fifteen subjects died with a functioning graft, 10 due to infections, two due to an acute myocardial infarction, two due to an acute pancreatitis and one due to a brain tumor. CONCLUSIONS: Survival of grafts and renal transplant recipients was not influenced by the type of donor, period of transplantation and immune variables. Main causes of recipient death were infections and the main cause of graft failure was acute rejection.

Adolescent↗