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Biomedical subjects

M E Suarez-Almazor

Publications and source records attributed to M E Suarez-Almazor.

At least 73 records · Page 4Linked to original sources
PubMed1997

Euthanasia and physician-assisted suicide: a comparative survey of physicians, terminally ill cancer patients, and the general population.

PURPOSE AND METHODS: There is an ongoing debate about the legalization of euthanasia. The attitudes and beliefs of the general public and physicians appear to differ; the views of patients have not been adequately explored. During 1995, we conducted a simultaneous survey in the province of Alberta, Canada, of a random sample of 1,240 individuals from the general population, 179 physicians, and 62 consecutive patients with terminal cancer. The same instrument was administered to the public and physicians through telephone interview, and to patients in a face-to-face interview. Statements related to the legalization of euthanasia and physician-assisted suicide were scored using 1-to-7 Likert agreement scales. RESULTS: A slight majority of members of the public and terminally ill patients (50% to 60%) agreed with the legalization of euthanasia and assisted suicide, while most physicians (60% to 80%) opposed it. In multivariate analysis, independent associations with support of active end of life measures included the following: group surveyed, strength of religious beliefs, religion (highest support by individuals with no religion), education (lower education associated with higher support), and the perception of burden on families, and physical and emotional suffering by cancer patients. CONCLUSION: In all groups, a marked polarization of attitudes was observed, with most individuals either strongly agreeing or strongly disagreeing with the statements in the survey. Although a slight majority of the public supported euthanasia, one third opposed it. Most physicians opposed these interventions and appeared not to be willing to perform these procedures if legalized. Our findings suggest that legalization at this time could be highly divisive and controversial from a societal perspective.

Adult↗
PubMed1997

Magnetic resonance changes in the temporomandibular joint in ankylosing spondylitis.

OBJECTIVE: To evaluate temporomandibular joint (TMJ) involvement of patients with severe ankylosing spondylitis (AS) using magnetic resonance imaging (MRI). METHODS: All patients with severe cervical involvement, defined as occiput-wall distance > or = 3 cm and/or < 10 degrees of cervical flexion, from a consecutive cohort of 103 patients with AS were included in the study. Patients completed a questionnaire designed to evaluate symptoms of temporomandibular disorder (TMD). Open and closed mouth sagittal T1 weighted MRI sequences of the right TMJ was performed in all patients. MR images were specifically reviewed for condylar position and morphology, as well as articular disc position and morphology. RESULTS: Eleven patients were identified and included in the study. Temporomandibular symptoms were absent in 4 (37%), a single symptom was present in one (9%), 2 symptoms in one (9%), 3 symptoms in 3 (27%), and 4 symptoms in 2 (18%). Ten of the 11 patients had abnormalities on MR, including condylar alterations such as abnormal shape, erosions, and reduction in translation. Disc alterations were present in 8 patients and osteophytes in 7. Two patients were graded as having mild abnormalities, another 2 as moderate, and the remaining 6 were considered grossly abnormal. In 2 patients there were changes compatible with ankylosis of the right TMJ. CONCLUSION: Although it is uncommon for patients to complain spontaneously about TMD symptoms, involvement of the TMJ in patients with severe AS appears to be frequent and, in some, severe. The effect of TMJ involvement on the overall well being and nutritional status in patients with AS remains to be determined.

Adult↗
PubMed1997

Variations and trends in the prescription of initial second line therapy for patients with rheumatoid arthritis.

OBJECTIVE: To evaluate practice variation and time trends in the initial prescription of second line drugs for the treatment of rheumatoid arthritis (RA) by a group of selected rheumatologists. METHODS: We retrospectively reviewed medical charts of all patients with a diagnosis of RA, initially seen between January 1, 1985, and June 30, 1994, by rheumatologists from a tertiary center and a rheumatology referral clinic in Edmonton. RESULTS: 1427 patients initially seen between 1985 and 1994 were included in the study. Of these, 1244 (87%) received a second line drug, 71% within 1.5 years after the disease onset. Overall, antimalarials and parenteral gold were the most frequently prescribed. Statistically significant trends were observed for the years under study. From 1985 to 1987, the most frequently prescribed initial second line drug was parenteral gold, between 1988 to 1990, sulfasalazine, and after 1991, antimalarials. Methotrexate was rarely used as a first choice. Marked variability was observed among rheumatologists in the use of initial second line drugs. In general, year of prescription and prescribing rheumatologist were significantly associated with the selection of all second line drugs but methotrexate. In addition, disease duration and residence (urban or rural) were associated with the selection of antimalarials and parenteral gold. CONCLUSION: Most patients were treated early with second line drugs. Initial prescription patterns varied among rheumatologists. These patterns have changed over the last 10 years. An increasing trend in the use of antimalarials was noted, and unlike prescription patterns in the US, methotrexate was rarely used as the first second line drug.

Antimalarials↗
PubMed1995

Incidence of myopathy in patients treated with antimalarials. A report of three cases and a review of the literature.

A retrospective review of 4405 patients' charts identified 214 patients who initiated antimalarial therapy between January 1987 and April 1993 for different rheumatic disorders (mean duration of therapy of 17 months). From these, three patients with myopathy were found for a total of 303 patient-years of therapy, for an incidence of 1 in 100 patient-years (95%, confidence interval 0.2-3). All three patients had rheumatoid arthritis and had received chloroquine for between 12 and 18 months with a maximum dose of 250 mg/daily. All had a muscle biopsy, but only one showed the classical rimmed vacuoles. All patients improved within 2 months after the drug was stopped. A review of the literature was carried out with special reference to the significance of clinical myopathy with a negative biopsy. We found that positive biopsies are usual only if the duration of symptoms have been allowed to persist for more than 6 months.

Adult↗
PubMed1995

Use of second line drugs for the treatment of rheumatoid arthritis in Edmonton, Alberta. Patterns of prescription and longterm effectiveness.

OBJECTIVE: Our purpose was to compare the patterns of prescription of 2nd line drugs for the treatment of rheumatoid arthritis (RA) among rheumatologists in Edmonton, Alberta, and to examine the longterm effectiveness of these drugs. METHODS: A 1985 inception cohort of 128 patients with RA was assessed between 1991 and 1992, using measures of disease activity, radiological scores and physical functional status. Use of different therapies was retrieved from the medical charts. RESULTS: All patients had seen a rheumatologist at any time between January, 1985 and December, 1991, 88% within the first 3 years of disease. Most (85%) had received at least one 2nd line drug, the majority within the first 2 years. Overall, gold salts were the most frequently prescribed drugs. Patterns of prescription varied among different rheumatologists; some drugs were never prescribed by some and very often by others (e.g., auranofin). Terminations because of toxicity and lack of efficacy were high. Methotrexate (MTX) had the lowest termination rate and sulfasalazine the highest, mostly due to lack of efficacy. CONCLUSION: In this cohort, patients were treated early in the course of RA. Patterns of prescription of 2nd line drugs varied among rheumatologists. Termination rates were highest for sulfasalazine and lowest for MTX.

Adrenal Cortex Hormones↗
PubMed1995

HLA-DR1, DR4, and DRB1 disease related subtypes in rheumatoid arthritis. Association with susceptibility but not severity in a city wide community based study.

OBJECTIVE: To determine the relationship of DR1, DR4, and DR4 subtypes with disease severity in patients with rheumatoid arthritis (RA). METHODS: We studied a cohort of 103 Caucasian patients with an onset of disease in 1985, and 6 to 7 years of disease at the time of the study. All rheumatologists in Edmonton participated in the city wide study which included hospital and community based patients with mild and severe disease. HLA status was determined using polymerase chain reaction amplification and amplified fragment length polymorphism typing. Outcome measures included joint counts, radiological scores, and physical functional status. RESULTS: Fifty-six patients (54%) were DR4 positive, (OR = 2.3, 95% CI 1.4-3.6, compared to controls). This association was only statistically significant for seropositive patients (OR = 2.8 in seropositive patients and OR = 1.5 in seronegative patients). A higher risk was observed for DR1/DR4 heterozygotes (OR = 6.8 in seropositive patients and OR = 1.7 in seronegative patients). No significant differences were observed in disease activity, joint counts, radiological scores, or functional status among patients carrying 1, 2 or no disease related alleles, although the prevalence of rheumatoid factor (RF) showed a linear association with allele dose (0, 1, or 2). CONCLUSION: DR4 and in particular DR1/DR4 heterozygosity were related to susceptibility to RA only in seropositive patients. RF was a better predictor of severity than disease related HLA subtypes. These findings suggest that the effect of these alleles on severity may be related to seropositivity, or that perhaps, seropositive and seronegative RA are genetically distinct entities. The results of our study suggest that in community based settings, which include patients with milder disease, DR1 and DR4 disease related alleles increase susceptibility for RA, but are not clinically useful as predictors of longer term outcome.

Alleles↗
PubMed1995

Frequency of atlantoaxial subluxation and neurologic involvement in patients with ankylosing spondylitis.

OBJECTIVE: To determine the prevalence of anterior and vertical atlantoaxial subluxation (AAS) and its neurological effect in a consecutive sample of Mexican patients with ankylosing spondylitis (AS). METHODS: Consecutive patients with a diagnosis of AS who attended 2 secondary care outpatient rheumatology clinic in the city of Guadalajara within a period of 6 mo were included in the study. Patients had prospective rheumatologic and neurologic assessments using structured questionnaires and examinations. Recorded variables included demographic data, disease characteristics, neurologic symptoms and signs, and axial mobility measurements. Somatosensory evoked potentials (SSEP) were performed in all patients. Patients also underwent standard cervical spine radiography with anteroposterior open mouth, and neutral, full flexion and extension lateral views. RESULTS: We studied 103 patients. Mean age was 35 yrs, 74% were male, and mean disease duration was 10 yrs (S/- SD 7.9). Anterior AAS was observed in 22 patients (21%, 95% CI 13-29%) and vertical AAS in 2 cases (2%, 95% CI 0-7%). Ossification of the posterior longitudinal ligament (OPLL) was present in 16 patients. Statistically significant associations were observed between anterior AAS and SSEP (p < 0.0001) and OPLL (p = 0.04). The degree of radiologic sacroiliitis was also associated with anterior AAS. After completion of the study, 2 patients required surgical fusion due to severe cervical cord compression. CONCLUSION: The prevalence of AAS and OPLL in this population was higher than previously reported in other settings. The association of anterior AAS with OPLL and radiological sacroiliitis could identify a subgroup of patients with more severe axial enthesopathy. Although clinically significant neurologic complications are not frequent in these patients, AAS may cause severe spinal cord compression requiring surgical fusion.

Adolescent↗
PubMed1994

Outcome in rheumatoid arthritis. A 1985 inception cohort study.

OBJECTIVE: Our purpose was to describe the clinical status and outcome of a 1985 inception cohort of patients with rheumatoid arthritis (RA), retrospectively established. METHODS: All patients with RA in Edmonton, with a possible onset of disease in 1985, and who consulted a rheumatologist at any time from January, 1985 through June, 1991 were considered for inclusion in the cohort. Patients were contacted and assessed between August, 1991 and June, 1992. The following indices were used as outcome measures: joint counts, radiological scores of hand radiographs and the modified Health Assessment Questionnaire for activities of daily living (MHAQ). RESULTS: One hundred and twenty eight patients were included in the cohort (70% were women; age at onset was 52 +/- 13 years). At the time of the assessment, 41 patients (32%) had no articular swelling. Twenty-nine patients (23%) had a radiological score of 0, and 39 (31%) had no erosions. The mean MHAQ score was 0.49 +/- 0.47; 39 patients (31%) had a score of 0 (normal function). Rheumatoid factors and nodules were related to more severe outcomes. Sex, age at onset and mode of onset were not related to prognosis. Most patients had received 2nd line therapy within the first 3 years of RA. CONCLUSION: Our results suggest that the prognosis of RA after 6-7 years of disease is not as ominous as has been suggested by others. Since most of the previous studies have been conducted in prevalent cases attending tertiary centers, a selection bias may be responsible for some of these results. Since these patients were treated early in the course of the disease, the beneficial effects of prompt 2nd line therapy cannot be excluded.

Adult↗
PubMed1993

The fluoridation of drinking water and hip fracture hospitalization rates in two Canadian communities.

OBJECTIVES: The purpose of this study was to compare hip fracture hospitalization rates between a fluoridated and a non-fluoridated community in Alberta, Canada: Edmonton, which has had fluoridated drinking water since 1967, and Calgary, which considered fluoridation in 1991 but is currently revising this decision. METHODS: Case subjects were all individuals aged 45 years or older residing in Edmonton or Calgary who were admitted to hospitals in Alberta between January 1, 1981, and December 31, 1987, and who had a discharge diagnosis of hip fracture. Edmonton rates were compared with Calgary rates, with adjustment for age and sex using the Edmonton population as a standard. RESULTS: The hip fracture hospitalization rate for Edmonton from 1981 through 1987 was 2.77 per 1000 person-years. The age-sex standardized rate for Calgary was 2.78 per 1000 person-years. No statistically significant difference was observed in the overall rate, and only minor differences were observed within age and sex subgroups, with the Edmonton rates being higher in males. CONCLUSIONS: These findings suggest that fluoridation of drinking water has no impact, neither beneficial nor deleterious, on the risk of hip fracture.

Aged↗
PubMed1992

Empirical assessment of the effect of different summary worklife exposure measures on the estimation of risk in case-referent studies of occupational cancer.

The effect of different summary measures of worklife exposure on the estimation of risk is reported. Two matched case-referent studies associating sulfuric acid exposure and cancer from Baton Rouge and southern Ontario were used. Five summary exposure measures were converted to discrete levels of exposure through the selection of equivalent percentile points on each measure's respective percentage frequency distribution for logistic regression modeling purposes. The southern Ontario data set exhibited only minor differences across all five exposure measures. The Baton Rouge data set, however, produced different results, and the time-dependent measures appeared to underestimate risk. It is possible, therefore, to obtain different estimates of risk depending on the exposure measure selected. It is recommended that, in the absence of proved models for assessing exposure, a variety of summary measures be used to estimate risk. This approach would facilitate the comparison of findings across studies.

Air Pollutants, Occupational↗
PubMed1990

The genetics of psoriasis. Haplotype sharing in siblings with the disease.

The purpose of this study was to determine whether the inheritance of psoriasis is HLA linked. We studied 12 families with at least two siblings with psoriasis. We used a sib pair analysis comparing the HLA haplotypes in affected siblings of these families. Haplotype sharing was analyzed in 15 sib pairs; expected frequencies of haplotype sharing were estimated as 25% for HLA identity and 50% for haplotype identity. All sib pairs shared at least one haplotype and 13 of the 15 were HLA identical, compared with the expected frequency of four. These results suggest that at least one, and probably more, HLA-linked genes are implicated in the development of psoriasis.

Disease Susceptibility↗
PubMed1990

Sacroiliitis in psoriasis: relationship to peripheral arthritis and HLA-B27.

One hundred and eighty-one patients attending a dermatology clinic were studied. Twenty-two (12%) were B27 positive. Twenty had peripheral psoriatic arthritis; 3 of these showed sacroiliitis (1 B27 positive, 2 B27 negative). Only one of the other 161 patients had sacroiliitis and he was B27 positive. Subsequently we examined 54 consecutive patients with psoriatic arthritis: 51 had peripheral arthritis (6 with sacroiliitis) and 3 exclusively axial involvement (2 sacroiliitis, one syndesmophytes with normal sacroiliac joints). All patients were pooled together and divided in 4 groups: B27 positive and negative, with or without peripheral arthritis. HLA-B27 and/or peripheral arthritis were associated with an increase in axial involvement. Patients lacking both B27 and peripheral arthritis did not have sacroiliitis and only in one case showed evidence of spinal disease (0.7%). Half of the patients with peripheral arthritis and spinal involvement were B27 positive. All 3 B27 positive patients without peripheral arthritis and with spinal disease were men and they all had bilateral sacroiliitis, indistinguishable from idiopathic ankylosing spondylitis (AS). HLA-B27 and peripheral arthritis appeared to act as separate factors that increased the risk of spinal arthritis in patients with psoriasis. The effect of B27 on psoriasis appeared to be detected in 2 different ways: as a coincidental factor increasing the risk of idiopathic AS (as for the general population) or as one of the multiple HLA associations that increase the risk of psoriatic arthritis; in this latter case the spinal involvement could occur as another manifestation of the clinical course of the disease.

Adult↗
PubMed1988

Normal cardiovascular autonomic function in patients with systemic sclerosis (CREST variant).

Sixteen consecutive patients with systemic sclerosis (CREST variant (calcinosis, Raynaud's phenomenon, oesophageal dysmotility, sclerodactyly, telangiectasia)) were included in this study. Standard non-invasive clinical and electrocardiographic procedures for the detection of cardiovascular autonomic insufficiency were performed in all patients and included heart rate (HR) response to deep breathing, Valsalva manoeuvre, and standing, and blood pressure (BP) response to hand grip and standing. None of the patients had overt cardiovascular disease or were receiving cardiovascular treatment at the time of testing. Results were compared with those obtained in 17 controls. A significant difference between patients and controls was observed only in the HR and BP response to standing (results of this last procedure were within the normal expected values in both patients and controls). We conclude that patients with systemic sclerosis and CREST syndrome may have an abnormal vascular response to standing; cardiovascular autonomic insufficiency, however, does not appear to be a significant feature in these patients.

Adult↗
PubMed1988

A randomized controlled trial of parenteral methotrexate compared with sodium aurothiomalate (Myochrysine) in the treatment of rheumatoid arthritis.

Forty patients with rheumatoid arthritis (RA) were enrolled in a double blind study of 26 weeks duration designed to compare the efficacy and safety of parenteral methotrexate and sodium aurothiomalate (GSTM) in the treatment of RA. All the patients had active RA and none had previously received gold, D-penicillamine or immunosuppressive therapy. Patients were randomized to receive weekly intramuscular (IM) injections of either methotrexate 10 mg or GSTM 50 mg. Two patients taking methotrexate and 7 taking GSTM were withdrawn before 26 weeks. Methotrexate was as effective as GSTM as measured by numbers of swollen or tender joints, morning stiffness, grip strength, pain scale and erythrocyte sedimentation rate. Five patients taking methotrexate and 11 taking GSTM presented side effects (p = 0.05). Total number of adverse reactions was 5 for the methotrexate group and 15 for the GSTM group (p less than 0.01). Our data suggest that low dose IM methotrexate is less toxic and as effective as GSTM for the treatment of RA during the first 6 months of therapy.

Adult↗
PubMed1988

Anterior atlantoaxial subluxation in patients with spondyloarthropathies: association with peripheral disease.

Anterior atlantoaxial subluxation is considered an uncommon feature of ankylosing spondylitis (AS). Six of 17 (35%) patients with spondylitis and peripheral arthritis had anterior atlantoaxial subluxation compared to none in a control group of 21 patients with AS with exclusively axial involvement (p = 0.009). Most of our patients with peripheral arthritis, with and without anterior atlantoaxial subluxation, also had an associated disorder (psoriasis, Reiter's or inflammatory bowel disease). Other features of radiologic cervical spine involvement (syndesmophytes and ankylosis) were equally present in all groups of patients (axial and peripheral arthritis, with or without subluxation). We conclude that anterior atlantoaxial subluxation is a frequent complication of the spondyloarthropathies in the presence of persistent peripheral disease and can occur in up to one third of these patients.

Arthritis↗
PubMed1987

B27 homozygosity and ankylosing spondylitis.

The frequency of B27 homozygosity was determined in 100 patients with B27 positive ankylosing spondylitis (AS). Six patients appeared to be B27 homozygous. The difference between the observed frequency of homozygosity of 6% and the expected frequency of 2.3% (from results on 725 blood donors) was not significant (p greater than 0.05). All 6 patients had moderate to severe disease. Subsequently, the families of 10 patients with AS were studied. The families were selected because 2 distinct B27 haplotypes were present. No difference was observed between the prevalence of AS in B27 homozygous or heterozygous family members. Although B27 homozygosity may have some influence on the severity of the disease, it does not increase the risk for AS even in families of patients with AS.

Adult↗