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Biomedical subjects

M Durán

Publications and source records attributed to M Durán.

At least 19 recordsLinked to original sources

[Autosomal recessive diseases with mental retardation].

INTRODUCTION: Autosomal recessive diseases with mental retardation are disorders that affect autosomes, and their genetic expression occurs in individuals who are homozygotic for a mutation, while heterozygotic subjects are unaffected carriers. If both parents are carriers, the theoretical possibility of their children also being carriers is 50%, the risk of the children being affected by the disease is 25%, and there is a 25% chance of their being healthy. They are an important source of mental deficiencies and inborn errors of metabolism (IEM) are some of their characteristic syndromes. DEVELOPMENT: The genetic disorders known as IEM can be classified according to the metabolism they affect, that is, purines, pyrimidines, amino acids, and so on. One of the lysosomal disorders is Tay-Sachs disease, which is rare among the general population but is very frequent in populations with a high rate of consanguinity, such as the Ashkenazi Jews. One of the most notable disorders affecting the metabolism of amino acids is the case of phenylketonuria due to mutations in the phenylalanine hydroxylase gene (PAH). It accounts for 0.5-1% of mental diseases and appears with a frequency rate of between 1/11,500 and 1/14,000 in newborn infants. Its early diagnosis through neonatal screening programmes makes it possible to start administering a phenylalanine-free diet and thus prevent mental retardation. CONCLUSIONS: Knowledge of this kind of autosomal diseases with neurological involvement, together with their correct and early diagnosis, makes it possible to establish suitable treatment regimens in some cases and to carry out genetic counselling in all of them.

Brain Diseases, Metabolic, Inborn↗

Prophylactic approach for asymptomatic post-menopausal women: osteoporosis.

To consider what a correct preventive approach for osteoporosis should be in the management of the asymptomatic post-menopausal woman. Literature review and opinions on this issue shared by a group of professionals with wide clinical experience in health care for peri- and post-menopausal women. There is agreement that osteoporosis combines most of the ideal requirements for the application of a preventive strategy. The natural evolution of this pathology leads to serious events, fractures, but it provides various opportunities for prevention. Osteoporosis can be avoided and in particular, fractures due to bone fragility and their consequences should be avoided. Nowadays, there are different courses of action (pharmacological or otherwise) with proven effectiveness for the prevention osteoporosis and osteoporotic fractures. However, long-term action is required for a broad segment of the population, so a certain strategy is necessary to guide clinical decisions for different profiles of women. There is little data in the literature to justify a different preventive approach, depending on the presence or absence of vasomotor symptoms, but clinical experience shows that their absence is not associated with a lower osteoporosis risk. Different strategies have been tried for the prevention of osteoporosis and its complications and some of them might be effective, but there is no analysis with conclusive results. A preventive strategy for osteoporosis should be included in the management of asymptomatic post-menopausal women, because this is an avoidable pathology and the absence of vasomotor symptoms does not reduce the risk of its development. Nevertheless, a well-designed cost-benefit analysis is needed to justify the implementation of any strategy at a community level, because adverse effects and economic cost could exceed the benefits obtained in low fracture risk populations.

Algorithms↗

Acute and mid-term combined hormone replacement therapy improves endothelial function in post-menopausal women with angina and angiographically normal coronary arteries.

AIMS AND BACKGROUND: Coronary endothelial dysfunction improves after acute oestradiol treatment in women with angina and normal coronary angiograms. We sought to analyse whether this effect is also seen in the peripheral circulation and whether it is sustained after a mid-term period of treatment. METHODS: We studied 20 women with angina, signs suggestive of myocardial ischaemia and normal coronary angiograms. In five of them, coronary and peripheral endothelial functions were studied at baseline. Brachial artery flow-mediated dilation was reanalysed after 24 h of transdermal oestradiol treatment. In the other 15 women, brachial artery vasoreactivity was studied at baseline and after a 6-week period of treatment with transdermal oestradiol and medroxyprogesterone (HRT) or placebo in a double-blinded crossover fashion. RESULTS: An abnormal coronary artery response to acetylcholine was observed in all women as well as impaired brachial flow-mediated dilation. Brachial flow-mediated dilation significantly increased after 24 h of oestradiol treatment (4.8+/-0.8% vs 0.06+/-0.6%, P<0.001). Peripheral flow-mediated dilation also increased after a 6-week period of HRT compared with baseline (4.1+/-3% vs 0.4+/-1%, P<0.01) and placebo treatment (4.1+/-3% vs 0.6+/-1.7%, P<0.01). CONCLUSION: Impaired endothelium-dependent vasodilation exists both at the coronary and peripheral circulation in post-menopausal women with angina and normal coronary angiograms. Flow-mediated dilation improves in these women after short and mid-term therapy with transdermal oestradiol irrespective of concomitant progesterone use.

Aged↗

Assessment of a monoclonal antibody-based competitive enzyme linked immunosorbent assay (cELISA) for diagnosis of brucellosis in infected and Rev. 1 vaccinated sheep and goats.

In this study a cELISA for the diagnosis of brucellosis due to B. melitensis in sheep and goats was evaluated and its capability of discriminating vaccinated from infected animals was assessed. Information is provided indicating that the cELISA has a diagnostic sensitivity (99.4%) and specificity (98.9%) in sheep and goats comparable to that of many standard indirect ELISA methods. In addition, the test proved able to distinguish between vaccinated and infected animals with an accuracy of up to 90% and results reproducibility of 93%. It was concluded that the cELISA could be useful for differentiation of Rev.1 vaccinated and naturally infected sheep and goats.

Animals↗

Biochemical markers of bone turnover after surgical menopause and hormone replacement therapy.

The objective of this study was to evaluate the effect of surgical menopause and hormone replacement therapy (HRT) on the new biochemical markers of bone turnover. Fourteen women who had undergone surgical menopause and began HRT 3 months after surgery were recruited for a 1-year study. Results were compared with a control group of 31 healthy premenopausal women of similar age. Serum samples were obtained to determine total alkaline phosphatase, bone alkaline phosphatase, propeptides carboxy- and amino-terminal of type I procollagen (PICP, PINP), osteocalcin, tartrate-resistant acid phosphatase, and carboxy-terminal telopeptides of type I collagen (ICTP and serum CTX). Urine samples were analyzed for hydroxyproline, pyridinoline, deoxypyridinoline, alpha- and beta-carboxy-terminal telopeptides of type I collagen (alpha-CTX and beta-CTX), and amino-terminal telopeptide of type I collagen (NTX). Determinations were performed after 3 months of surgical menopause and after 3 and 9 months of HRT. All biochemical markers increased after menopause, and most of them normalized after 9 months of HRT. Serum PINP showed the highest proportion of increased values after surgery among bone formation markers (62%), as well as the highest mean percent increase (101%). Among bone resorption markers in postmenopausal women, urinary beta-CTX, alpha-CTX, NTX, and serum CTX showed the highest proportion of increased values (100%, 67%, 58%, 58%, respectively) as well as the greatest mean percent increase. They were also the markers with the most marked response to HRT. In conclusion, serum PINP is the most sensitive marker of bone formation, whereas beta-CTX is the most sensitive marker of bone resorption after surgical menopause. In addition, both markers showed the highest response after HRT.

Acid Phosphatase↗

Magnetic resonance study of the pancreatic duct.

AIM: to prospectively determine the diagnostic accuracy of magnetic resonance cholangiopancreatography (MRCP) in the evaluation of the normal and diseased pancreatic duct. METHODS: patients seen during a 6-month period with a diagnosis of biliary tract or pancreatic disease underwent endoscopic retrograde cholangiopancreatography (ERCP) after a previous MRCP. The pancreatic duct was evaluated with both techniques in 37 patients. RESULTS: the pancreatic duct appeared normal in ERCP in 27 patients, and also appeared normal in MRCP in 25 of these patients (specificity 93%). ERCP showed moderate-severe pancreatic duct dilation in 8 patients, in whom the same diagnosis was reached with MRCP (sensitivity 100%). The causes of dilation were chronic pancreatitis (2 patients), pancreatic cancer (3 patients) and ampullary tumor (2 patients); in 1 patient the findings with both techniques were suggestive of neoplasm of the head of the pancreas or focal chronic pancreatitis. Pancreas divisum was diagnosed in 2 patients by both methods, and the predominant dorsal duct as well as the ventral duct were visualized by MRCP. CONCLUSIONS: MRCP is an accurate technique for evaluating the normal or diseased pancreatic duct, and for determining the underlying disease.

Aged↗

The effect of hormone replacement therapy on bone mass in patients with ovarian failure due to bone marrow transplantation.

BACKGROUND: Long permanent remissions in malignant hematopoietic disorders can often be achieved by autologous bone marrow transplantation (ABMT) or by allogenic bone marrow transplantation (BMT). Previous studies have shown that such therapies may induce osteoporosis due to iatrogenic ovarian failure. The administration of hormone replacement therapy (HRT) in these women could prevent the adverse effects of long-term ovarian failure without remarkable side effects. The aim of this study was to evaluate how the bone mass is affected by HRT in patients undergoing ABMT or BMT adjusting the results for age, weight, and height. SUBJECTS AND METHODS: Thirteen women with previous ABMT/BMT were treated with a standard dose (0.625 mg/day) of conjugated equine estrogen (CEE) or with 50 micrograms/day of 17-beta-estradiol in transdermal therapeutic systems (TTS) plus 5 mg/day of medroxyprogesterone acetate sequentially added to the last 12 days of estrogen therapy. Bone mass was measured prior to and 12 months following HRT. Blood samples were collected before therapy and during the 6th and 12th treatment months. RESULTS: The mean time elapsed between bone transplantation and HRT initiation was 13.0 months (range 3-26 months). Before treatment nine patients were osteopenic and after HRT bone mass increased in all cases. Following ABMT/BMT, hepatic hyperenzymemia was detected in three patients. After 6 and 12 months of treatment no significant changes were observed in hepatic enzymes. CONCLUSION: Although hepatic hyperenzymemia is commonly considered as a contraindication for HRT, our results suggest that HRT is safe for these patients and that such therapy should be initiated after transplantation in women to prevent adverse effects of long-term ovarian failure.

Administration, Cutaneous↗

[Hashimoto toxicosis: diagnostic criteria and a 10-year follow up].

An study was carried out of the association of Basedow disease (B) and Hashimoto toxicosis (H), the response to the usual therapeutic regimens and prognostic factors for the clinical course. Seventy-one patients with the diagnosis of autoimmune hyperthyroidism were included. Sixty-one of them were prospectively followed for 8.4 +/- 2.2 years (range: 5-10 years). All patients were treated following the same criteria with antithyroid drugs and aggressive therapy (radioiodine or surgery). Two groups were differentiated: group H (62%), with titers of antimicrosomal antibodies (AMSA) > or = 1/6,400 and a positive perchlorate discharge test (PDT), and group B, with AMSA titers < 1/6,400 and negative PDT. During follow-up a three-fold number of relapses was observed in group H compared with group B, a higher frequency towards spontaneous hypothyroidism in the evolution (23% in H versus 0% in B), and higher requirements of radioiodine in H than in B. In our experience, H makes up and important percentage of autoimmune hyperthyroidism (62%) with a clinical course characterized by a higher number of relapses, higher requirements of radioiodine and a higher rate towards spontaneous hypothyroidism.

Adolescent↗

Sequential gonadotrophin-releasing hormone agonist/low-dose oral contraceptive treatment for leiomyomata uteri.

On the basis that gonadotrophin-releasing hormone agonists (GnRHa) induce a significant but transient shrinkage of leiomyomas and that oral contraceptive use may be associated with a decreased risk of fibroids, we tested the hypothesis that sequential GnRHa/low-dose oral contraceptive treatment could be a therapeutic alternative in perimenopausal women with uterine fibroids. Six premenopausal women with leiomyomata uteri were treated with D-tryptophan-6-luteinizing hormone-releasing hormone (D-Trp-6-LHRH) depot (Decapeptyl 3.75) for 6 months and demonstrated a significant reduction in mean uterine volume. A low-dose oral contraceptive containing 30 micrograms of ethinyl oestradiol plus 150 micrograms of desogestrel was given during the ensuing 12 months. When GnRHa therapy was discontinued, there was a rapid regrowth of the uterine fibroids and the uterine volume had reached, or even exceeded, pretreatment values by the eighth to 12th month of contraceptive therapy. Sequential GnRHa/low-dose oral contraceptive treatment is not a useful tool for leiomyomata uteri.

Adult↗

Transvaginal sonography of the endometrium in postmenopausal women: monitoring the effect of hormone replacement therapy.

BACKGROUND: It is well known that progestins given in sufficient dosage reduce the risk of endometrial cancer and endometrial hyperplasia. It is also not uncommon that patients receiving hormone replacement therapy (HRT) require endometrial biopsy in order to evaluate the effects of oestrogens and progestogens on endometrium. However, endometrial biopsy is often associated with pain and discomfort, and transvaginal sonography has been suggested as a new and painless method of monitoring the effects of HRT on the endometrium. METHODS: Transvaginal ultrasonography was performed in a series of women on several regimens of HRT immediately prior to endometrial biopsy (Cornier cannula). We correlated the morphology and thickness of the endometrium as assessed by transvaginal ultrasonography with the endometrial histology. Patients were assigned into four groups. The first (n = 15) received 0.6 mg/day of conjugated equine oestrogen (CEE) cyclically and the second (n = 6) received 50 micrograms/day of transdermal oestradiol cyclically. All these groups also received 5 mg of medroxy-progesterone acetate (MPA) sequentially for the last 12 days of HRT, while the third therapy group (n = 7) received 0.625 mg/day of CEE and 5 mg/day of MPA uninterruptedly. The fourth group (n = 8) constituted a treatment-free control group. In total 36 biopsies were taken. Our initial results suggest that endometrial thickness under 4 mm measured by ultrasonography is not associated with endometrial abnormalities and that transvaginal ultrasonographic scanning of the endometrium may be a useful tool in determining which patients require endometrial histologic evaluation and perhaps in detecting those who need adjustment in the progestin dosage.

Administration, Cutaneous↗

[Complete atrioventricular block and rupture of the interventricular septum in a child following closed thoracic traumatism. The usefulness of Doppler color echocardiography].

We report a case of a 6-year-old child with a third-degree atrioventricular heart block, ventricular septal rupture, tricuspid regurgitation and pericardial effusion after closed chest trauma. The role of the two dimensional echocardiography and color Doppler flow study in the early and reliable detection of cardiac lesions due to blunt chest traumas pointed out.

Child↗

Nosocomial infections in pediatric patients: a prevalence study in Spanish hospitals. EPINE Working Group.

BACKGROUND: The magnitude of the problem of nosocomial infection in children has never been studied in Spain. METHODS: In 1990, a nationwide cross-sectional study was conducted to determine the prevalence of nosocomial infection and associated risk factors. RESULTS: Among 38,489 patients surveyed, 4081 were pediatric patients. Three hundred forty-five patients (8.4%) had active nosocomial infection at the time of the survey. Pediatric intensive care units (29.7%), hematology (23%), and special units (22%) showed the highest rates. Infections were most common in patients younger than 1 year (prevalence, 12.3%). Frequencies of nosocomial infection by site were as follows: bloodstream, 22.1%; urinary tract, 13.1%; lower respiratory tract, 12.3%; postoperative wound, 8%; gastrointestinal tract, 7.6%; skin, 6.5%; eye, 5.8%; and others 24.6%. The factors most closely associated with a higher prevalence of nosocomial infection in pediatrics were as follows: age younger than 1 year, surgery, moderate and severe baseline risk, number of diagnoses, and all categories of extrinsic risk factors. The most frequent etiologic agents were gram-positive bacteria (45.8%). CONCLUSIONS: Although the overall prevalence is at an acceptable level, future efforts should be focused on developing more effective prevention strategies in specific areas.

Adolescent↗

[The atrial contribution to ventricular filling in mitral stenosis. An evaluation by Doppler echocardiography].

Using Doppler echocardiography, we have quantified the atrial contribution to ventricular filling in 22 patients with mitral stenosis in sinus rhythm without or with minimal mitral and/or aortic regurgitation. With continuous wave Doppler from apex we obtained the ventricular filling flow from which the valvular area was calculated. The product of the integrated ventricular filling waves multiplying by the valvular area was called total volume (TV). Assuming that the deceleration of the ventricular filling flow is linear and remain constant, we integrated the transmitral flow, this time without considering the atrial filling wave as if the patient was entering into atrial fibrillation. Multiplying this integration by the valvular area we obtained a second volume, atrial fibrillation volume (AFV). The atrial contribution was calculated by: 1) absolute value: TV-AFV and in 2) percent value or fraction: (TV-AFV/TV) x 100. When we correlate absolute and percent values with mitral valve area, the results were statistically significant in both cases (p less than 0.001), with an excellent regression factor both with absolute value r = 0.90 and the percent one r = 0.72. In mitral stenosis the atrial contribution to ventricular filling has an inverse relation with the grade of severity, being very low in the more severe lesions. This is why it would be doubtful that its lost (atrial contribution) is the only cause of hemodynamic deterioration that has been observed in patients who suddenly present atrial fibrillation.

Adolescent↗