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Biomedical subjects

M Bosque

Publications and source records attributed to M Bosque.

15 recordsLinked to original sources
PubMed2000

Home intravenous antibiotics for cystic fibrosis.

BACKGROUND: Recurrent endobronchial infection in cystic fibrosis requires treatment with intravenous antibiotics for several weeks, which is usually administered in hospital, affecting health costs and quality of life for patients and their families. It is not known whether patients receiving intravenous treatment at home have better or equivalent health outcomes, if costs are reduced or if it is preferred than in-hospital treatment. Home treatment requires training to patients and carers and usually needs a few previous days in hospital. OBJECTIVES: To determine whether home intravenous antibiotic therapy in cystic fibrosis is as effective as in-patient intravenous antibiotic therapy and if it is preferred by patients and/or families. SEARCH STRATEGY: References to trials were obtained from the specialist cystic fibrosis trials register held by the editorial base of the Cochrane Cystic Fibrosis and Genetic Disorders Group. Handsearching of the abstracts books of all Spanish Conferences on cystic fibrosis and the last European Conference (Stockholm, 2000) was carried out by authors. SELECTION CRITERIA: Randomised controlled trials where home intravenous antibiotic treatment for patients with cystic fibrosis was compared with in-hospital intravenous antibiotic treatment, including adults and children with cystic fibrosis. All kinds of antibiotics and regimens administered intravenous were included. DATA COLLECTION AND ANALYSIS: Three reviewers independently selected the trials to be included in the review, assessed methodological quality of each trial and extracted data using a standardised form. Because of several limitations, narrative synthesis was used at this stage. MAIN RESULTS: One study was included with 17 patients aged 10 to 41 years with an infective exacerbation by Pseudomonas aeruginosa. All their 31 admissions were analysed as independent events. Outcomes were measured at 21 days of follow-up after initiation of treatment. Home patients had fewer investigations performed than hospital patients (p<0.002) and general activity was higher in the home group. No differences were found for clinical outcomes, adverse events, complications of intravenous lines or line changes or time to next admission. Home patients received less low-dose home maintenance antibiotic. Quality of life measures showed no differences for dyspnoea and emotional state, but fatigue and mastery were worse for home patients, possibly due to a higher general activity and need of support. Personal, family, sleeping and eating disruptions were less important for home than hospital admissions. Home therapy was cheaper for families and the hospital. Indirect costs were not determined. REVIEWER'S CONCLUSIONS: The current evidence is restricted to one small study. It suggests that in the short term home therapy does not harm patients and in general reduces social disruptions. The decision to attempt home treatment should be based on an individual basis and appropriate local resources. More research is urgently required.

Adult↗
PubMed1996

MHC class II alleles associated with clinical and immunological manifestations of HIV-1 infection among children in Catalonia, Spain.

Children with perinatally-acquired HIV-1 infection were studied to determine if major histocompatibility complex (MHC) genes are involved in progression to pediatric AIDS. Molecular genetic techniques were used to genotype loci in the class II region (DRB1, DQA1, DQB1, DPA1, DPB1, LMP2 and LMP7). HIV-infected children were classified by clinical manifestations and degree of immunosuppression using age-specific CD4 T-lymphocyte counts at enrollment. Alleles at the DPB1 and DQB1 loci showed independent and opposite associations; DPB1*0301 showed a trend toward protection while DQB1*0201 appeared to be a risk factor for developing severe immunosuppression and severe clinical outcomes. Presence of DQB1*0201 conferred a greater than 10-fold increased odds of having severe clinical manifestations and a 2.8-fold increased odds of severe immunosuppression. Presence of DPB1*0301 was associated with a greater than 8-fold decreased odds of severe immunosuppression and severe clinical manifestations. These results support host genetic influences on HIV-1 outcomes in children.

Alleles↗
PubMed1993

[A prognostic multifactorial study of sepsis in an internal medicine service].

All cases of sepsis attended at the Service of Internal Medicine from 1985 to 1989, both inclusive, were retrospectively analyzed by the statistical study of several clinical, epidemiological, bacteriological and laboratory factors. The parameters acting as prognosis factors were analyzed using Cox's method of logistic regression, in order to obtain more reliable information on the multifactorial spectrum determining "death due to sepsis". The unifactorial analysis (UFA) suggested that the following factors were associated to an statistically significant increase in the mortality due to sepsis: age above 70; male sex; presence of shock upon hospitalization; nosocomial etiology; high levels of urea, creatinine and LDH; proteinuria; family of the causal germ (gram-positive coccus) and underlying pathology. The relative risks (RR) or "odd ratios" of creatinine and LDH were, respectively, 2.8 and 2.9 in the UFA; 3 and 3.3 in the multivariant analysis (MVA). In the older patients developing sepsis within their communities, RR were respectively 2.7 and 1.98 in the UFA and 1.1 and 2.7 in the MFA. The results of the univariant and multivariant analysis showing the relative risk (odd ratio) associated to each of these variables with statistical significance, demonstrate that the mortality rate due to sepsis increases with age, nosocomial etiology and elevation of creatinine and lactodehydrogenase (LDH) levels. We stress the great importance of the LDH as a prognostic factor of sepsis.

Adolescent↗
PubMed1983

Growth after renal transplants.

The growth of every child with a bone age less than 15 years who received a first renal transplant between 1975 and 1980 was analysed to determine the growth expectation of children with renal transplants substantially maintained on alternate-day prednisolone. Growth was expressed as a standard deviation score defined as the difference between the standard deviation for height at the time of the transplant and at the end of 1981. Average growth achieved by the 46 children. 41 with functioning transplants, was normal with a mean standard deviation score of +0.7 +/- 0.3 (SEM) for boys and -0.3 +/- 0.3 (SEM) for girls; 25 of the children had accelerated growth. Mean standard deviation scores per year of advance of bone age in 29 children was +0.003, which suggested no overall loss of growth potential. No difference in growth per year of advance in bone age was detected in children with a bone age less than 12 years at transplant compared with more mature children, but boys with a bone age less than 12 years grew better per year of advance in chronological age; this appeared to be related at least in part to their greater growth deficit at transplant. Glomerular filtration rate, alternate-day prednisolone dose, and level of plasma phosphate did not appear to affect growth in the 11 prepubertal children with functioning first grafts.

Adolescent↗
PubMedDate not supplied

[Immunotherapy with acarus extract in children under the age of 5 years].

BACKGROUND: Specific immunotherapy with allergens is the only treatment capacite of modifying the natural course of allergic diseases. Although its effectiveness is higher when started in early stages, WHO guidelines still consider age under 5 years as relative contraindication.A review of a group of 22 children starting immunotherapy before the age of 5 years in a pediatric allergy unit was attempted to assess the effectiveness and safety of this treatment. METHODOLOGY AND RESULTS: Clinical charts of 22 children with house dust mite asthma starting conventional immunotherapy before the age of 5 years were reviewed. In all cases, biologically standardized extracts and conventional subcutaneous schedules have been used and administration was performed in a hospital setting. Effectiveness and safety were evaluated by clinical scores. The average treatment period was 16.95 ( 10.12) months. Systemic reactions (moderate) were observed in 7 children and local reactions in 5. Children treated for more than 1 year (15 patients) showed a decrease in the number of yearly acute exacerbations (from 5.13 to 2.57) and in hospital admissions (from 5 to 2 children). In 10 patients, drug requirements for bronchial asthma were reduced. CONCLUSION: The clinical data if this study suggest that house dust mite specific immunotherapy under hospital control can be begun in young children with good tolerance and clinical improvement.

Age Factors↗
PubMedDate not supplied

Effects of specific immunotherapy on the development of new sensitisations in monosensitised patients.

BACKGROUND: Specific immunotherapy (SIT) is the only treatment that interferes with the basic pathophysiological mechanisms of allergic disease and is widely used in the management of clinically significant respiratory IgE-mediated diseases. Nevertheless, until recently, information on the influence of SIT on the development of new allergic sensitisations has been scant. METHODS: One hundred consecutive patients (45 males and 55 females, aged 6 to 69 years) with respiratory allergic diseases and attending the allergy unit of a general hospital were selected. All had been diagnosed by clinical history and skin prick tests of allergic rhinitis and/or asthma, were monosensitised (71 to Dermatophagoides spp, 22 to Parietaria judaica pollen and 7 to grass pollen) and had been followed up as outpatients between 1990-98. Sixty-six patients had been treated with conventional SIT for at least 3 years, while thirty-four followed only environmental measures and drug treatment. Family atopy status (first-degree relatives), smoking, family pets (cat and/or dog), rhinitis and/or asthma symptom score and inhalant skin prick tests to the same aeroallergens were compared between baseline and after 3 to 5 years of treatment. RESULTS: No statistically-significant differences in the development of new sensitisations were observed between the two groups (36.4 % of SIT-treated patients versus 38.2 % in control group, RR = 0.97, CI 95 %: 0.72-1.3). Smoking, family atopy history and pets did not appear to be risk factors for the development of neosensitisations (p < 0.05). Nevertheless, SIT-treated patients presented a better clinical score than the control group, with improvements of 89.4 % and 61.8 %, respectively (p = 0.007). CONCLUSIONS: Three-year SIT did not protect against development of new sensitisations in monosensitised allergic rhinitis or asthma. Smoking, family atopy history and pets were not associated with development of new sensitisations. Clinical score improved significantly in the SIT-treated group compared with drug-treated patients.

Adolescent↗
PubMedDate not supplied

A prospective and multicenter safety-monitoring study of a short up-dosing schedule of immunotherapy with a mass-units-standardized extract of mites.

A prospective, multicenter pharmacovigilance study was carried out to evaluate the safety of a new 7-dose treatment schedule of subcutaneous immunotherapy as opposed to the conventional 13 doses normally recommended. The study was carried out in 14 centers and included 261 patients (children and adults) with respiratory allergic disease due to sensitization to mites (Dermatophagoides pteronyssinus and/or farinae). A total of 2290 doses were administered under the direct supervision of the participating specialists. One hundred and ten reactions in 63 patients (24.1%) were recorded, representing 4.8% of the total doses administered. Most of the reactions (98) were local. Only 12 were systemic (0.5% of the administered doses) and occurred in 10 patients (3.8% of the sample). Ten reactions reverted quickly with rescue medication. The maintenance dose had to be lowered in one patient and another patient was withdrawn from the study after suffering two asthmatic crises after two consecutive doses. In view of the results obtained, we can conclude that the new schedule shows an acceptable tolerance profile and does not present a greater risk of reactions than the conventional scheme of 13 doses using an identical extract. Moreover, the new schedule represents substantial savings in the number of doses and visits required to reach the maintenance dose.

Adult↗
PubMedDate not supplied

[Allergic rhinitis and bronchial hyperreactivity].

BACKGROUND: Bronchial hyperreactivity (BHR) is a characteristic of bronchial asthma. Patients with allergic rhinitis who do not report symptoms of bronchial asthma on spirometry show BHR, which could indicate the presence of subclinical inflammation of the lower respiratory airway. The aim of this study was to investigate whether the patients diagnosed with allergic rhinitis in our unit without symptoms of bronchial asthma had bronchial hyperreactivity and to determine which allergens caused these symptoms in our patients. METHODS AND RESULTS: We performed a retrospective, observational study of patients diagnosed with allergic rhinitis in our Allergy Unit between August 2000 and December 2001. The patients' medical records were reviewed and data on the following were gathered: demographic information, age, sex, rhinitis symptoms (perennial or seasonal), conjunctivitis, atopic dermatitis, bronchitis, sensitization (specific IgE, skin tests, nasal challenge tests), total IgE levels, spirometry performed through stress test (positive with a decrease of FEV1 > 15 % with stress or an increase of FEV1 of 12 % after bronchodilation) and family history of allergic disease. A total of 135 medical records of patients with allergic rhinitis were reviewed. Of these, 68 did not report symptoms of bronchial asthma (35 men and 33 women aged between 4 and 18 years). Most of our patients (50/68) reported perennial asthma and were sensitized to mites (44/68). In 14/68 spirometry was not performed at diagnosis. Stress test was positive in 13/54 (24 %). All patients who showed bronchial hyperreactivity were sensitized to mites and only one of these reported seasonal rhinitis. CONCLUSIONS: According to the latest guidelines on the treatment and control of allergic rhinitis --The Allergic Rhinitis and its Impact on Asthma Workshop Report-- bronchial asthma and allergic rhinitis are distinct manifestations of a single airway and of the same disease. In view of our results, we recommend systematic evaluation of bronchial hyperreactivity in the study protocol of allergic rhinitis in patients who do not report symptoms of bronchial asthma.

Adolescent↗
PubMedDate not supplied

[Multicenter drug surveillance of sublingual immunotherapy in allergic patients].

A study of pharmacovigilance has been performed in 522 patients suffering from allergic rhinitis and/or asthma. Sensitization was due to pollens and mites in ther majority of cases. The treatment consisted in biologically standardized glycerinated allergenic extracts for specific sublingual immunotherapy (SLIT) and, major allergens were also quantified, depending on the allergenic composition. The aims of the study were to assay the effect of the SLIT in a short-and-medium-term course and to know the adverse reactions most frequently appearing, as well as the unexpected side effects that are only possible to know through the study of a numerous sample of patients. We also evaluated the factors that can modify the tolerance of the treatment, such as the onset of patient's disease and its severity. All the patients had a clinical history of, at least, two years of evolution and positive skin-prick test to the allergen/s cause of their atopic disorder. Exclusion criteria were immunotherapy in the last two years, pregnancy and those situations in which the immunotherapy is contraindicated according to the EAACI requirements. In order to carry out the daily record of the SLIT as well as the possible appearance of symptoms, two diaries were given to each patient. Tolerance was evaluated by the physician at the end of the build-up phase (3 months) and when the maintenance phase finished (5 months later). Total administered doses were 44.021, the final number of patients who registered any adverse reaction in relation with SLIT was 41 (7.9%), with a number of 67 adverse reactions that means a 0.15% over the total administered doses.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Sublingual↗
PubMedDate not supplied

[Early endoscopic findings of the upper respiratory and digestive tract in patients undergoing translaryngeal intubation for more than 24 hours].

The large number of patients undergoing translaryngeal intubation justifies acquiring full knowledge of the complications that this invasive procedure may produce. The short-term problems that cause immediate complications (esophageal intubation, cuff rupture) are severe and do not escape notice. However, less immediate problems often pass undetected, although their presence may worsen the patient's outcome. Endoscopy allows the condition of the upper respiratory and digestive tract to be examined in order to detect and correct such problems. In this preliminary study, risk factors are analyzed and the lesions are described, classified, and quantified. Forty-seven adult patients were studied prospectively. In the first 24 to 48 hours of intubation, rigid endoscopy was performed under sedation using 0 degree and 30 degrees rigid endoscopes. The high rate of glottic edema (63.8%) was noteworthy because knowledge of this condition can be vital for preventing extubation failure.

Adolescent↗