PubMed Health⌕ Search

Biomedical subjects

M Gil

Publications and source records attributed to M Gil.

At least 55 records · Page 3Linked to original sources
PubMed1999

Relationship of therapeutic improvements and 28-day case fatality in patients hospitalized with acute myocardial infarction between 1978 and 1993 in the REGICOR study, Gerona, Spain. The REGICOR Investigators.

BACKGROUND: The aim of this study was to analyze 28-day case fatality trends between 1978 and 1993 among hospitalized acute myocardial infarction (AMI) patients in the REGICOR registry, Gerona, Spain, and relate them to thrombolytic and antiplatelet drug use and changes in patient characteristics. METHODS AND RESULTS: A total of 2053 consecutive patients 25 to 74 years of age with a first Q-wave AMI admitted to the reference hospital between 1978 and 1993 were registered. Clinical characteristics and patient management were recorded. Four 4-year periods were considered: 1978 to 1981, 1982 to 1985 (prethrombolytic therapy), 1986 to 1989 (thrombolytic and antiplatelet drugs introduced), and 1990 to 1993 (thrombolytic and antiplatelet drugs used routinely). The end point was death at 28 days. Case fatality at 28 days decreased 6% per year between 1978 and 1993. A logistic model adjusted for comorbidity and severity showed the last 3 periods to present a steep decrease in the OR of death at 28 days: 0.86 (95% CI, 0.52 to 1.41), 0.59 (95% CI, 0.35 to 0.99), and 0.40 (95% CI, 0.24 to 0.69), respectively, compared with the first period. After 1986, 85.7% of the 112 lives saved could be attributed to the use of antiplatelet and thrombolytic drugs. Adjusted relative risk reduction was 56.0% for antiplatelet drugs, 34.1% for thrombolytic drugs, and 77.9% for the 2 combined. CONCLUSIONS: Our results strongly suggest that new therapies introduced since 1986 have contributed to the decrease in 28-day case fatality of patients admitted with a first Q-wave AMI. This decrease could be attributable mainly to the use of antiplatelet and thrombolytic drugs. These findings should encourage the routine use of thrombolytic and antiplatelet drugs and particularly their combination in the acute phase of AMI.

Adult↗
PubMed1999

[Epidemiology of sudden cardiac death in Spain].

Sudden cardiac death is a remarkable public health problem though its incidence in Spain is lower than in other industrialised countries. Approximately 12% of all natural deaths occur suddenly, and 88% of them are of cardiac origin. This is the form of death in more than 50% of coronary heart disease patients. Moreover, it is the first symptom in 19-26% of cases. This close relationship with coronary heart disease results in cardiovascular risk factors being also risk factors for sudden death. Several factors, such as physical activity or certain drugs may act as sudden death triggers. The more effective strategy addressed to sudden cardiac death prevention includes identification high-risk subgroups of patients (i.e. patients with previous coronary heart disease, heart failure, out-of-hospital sudden death survivors and patients who developed a ventricular fibrillation or tachycardia after a myocardial infarction) and development of efficacious therapeutic interventions. Given that most sudden death are related to coronary heart disease, those primary preventive measures directed to reduce the coronary heart disease incidence rates will also prevent sudden cardiac deaths in population. Finally, community programs directed to reduce the time to reach cardiac emergencies by trained personnel, and to train general population in cardio-respiratory reanimation have shown to be efficacious owing to the fact that most sudden cardiac deaths occur out of hospitals.

Adult↗
PubMed1999

Safety of dobutamine-atropine stress echocardiography: A prospective experience of 4,033 consecutive studies.

Dobutamine-atropine stress echocardiography (DASE) is an established method and has been shown to be accurate for the detection of coronary artery disease. Still, there are few large clinical studies that analyze the safety of DASE in general or the safety of performing it on an ambulatory basis. Most studies use a target heart rate as the primary end point regardless of whether asymptomatic ischemia occurs. Such studies have shown a serious cardiac event rate of approximately 0.3%. We prospectively studied 4,033 consecutive patients on an ambulatory basis and in the hospital with the use of DASE from July 1991 to December 1998. All tests were performed by an experienced physician, and all clinical and DASE data were stored in a large database organized at the beginning of the study. Dobutamine was infused in scalar doses of 5, 10, 20, 30, and 40 microg/kg per minute in 3-minute stages. Development of a new wall motion abnormality, achievement of 85% of target heart, and end of the DASE infusion protocol were used as an end point. If 85% of the target heart rate was not achieved, atropine was infused up to 1 mg in the absence of myocardial ischemia, which was used in 1,280 studies. There were 3,645 diagnostic tests, and 388 (10%) were found to be nondiagnostic. This result was due to poor image quality in 115 (3%), end of protocol in negative-submaximal examinations in 124 (3%), and limiting side effects in 149 (4%). Thirty-seven percent of the tests showed positive results for myocardial ischemia. Major test-related cardiac complications occurred in 10 (0.25%) patients and included 1 ventricular fibrillation, 1 case of myocardial infarction, and 8 cases of sustained ventricular tachycardia. Atropine poisoning was observed in 5 (0.12%) patients. No deaths occurred as a direct or indirect consequence of DASE. We conclude that dobutamine-atropine stress echocardiography is a reasonably safe method for detection of coronary artery disease in the hospital or in an ambulatory basis. The use of new wall motion abnormality as 1 of the end points may prevent further ischemia-related complications.

Adolescent↗
PubMed1999

Phaeohyphomycosis in kidney transplant patients.

Dematiaceous fungi are being increasingly recognized as pathogens in organ transplant recipients. This investigation reports five cases of subcutaneous phaeohyphomycosis that occurred in five kidney transplant recipients in the Renal Unit at the San Vicente de Paul Hospital, Medellin, Colombia. Fungi of the genus Exophiala were isolated in three cases, but the agent was not identified in two cases. Physicians are likely to develop increased awareness of the clinical manifestation of infection with the dematiaceous fungi as the population of immunocompromised hosts continues to grow.

Antifungal Agents↗
PubMed1999

Isolation of speech area syndrome (ISAS): a follow-up study--a rehabilitative approach.

PURPOSE: In this study we present our findings concerning the dynamics of language modalities in the isolation of the speech area syndrome (ISAS). The aim of the study was to establish: (1) the linguistic characteristic features of this group of patients; (2) the course of dynamics of language of each patient; (3) whether this course of dynamics is common for the whole group; (4) whether the course of dynamics we found matches with the report in the literature. METHOD: Over a period of 5 years, nine patients with ISAS were diagnosed and treated in our department. They received varying lengths of treatment, and four were followed for 2-6 years after discharge. RESULTS: Despite the common belief that the prognosis for language rehabilitation for these patients is poor, we found that some ISAS patients improved, even dramatically, after prolonged language treatment. CONCLUSION: It is hoped that these findings will alter clinicians' attitudes towards these patients, and provide some hope for rehabilitation outcome.

Adult↗
PubMed1999

Long-term results of the Spanish trial on treatment and survival of patients with predominantly mild heart failure.

A randomized open-label clinical trial was conducted to determine whether mortality, readmission, or quality of life differed between heart failure patients managed with captopril plus diuretics and those with digoxin plus diuretics. A total of 345 heart failure patients in New York Heart Association functional classes 2 and 3 without atrial fibrillation, dyspnea of bronchopulmonary origin, or hypertension not controlled with diuretics was randomized for digoxin (n = 175) or captopril (n = 170) treatment and followed up for a median of 4.5 years. Socioeconomic, demographic, electrocardiographic, echocardiographic, spirometric, and chest radiograph data were obtained at the initial examination. In a random sample of half the patients, ergometric, echocardiographic, and Holter records were obtained at entry and at 3 and 18 months. Patients were followed up for > or = 3 years. The end points were mortality, hospitalization for cardiac events, deterioration in quality of life, worsening of functional class, and need for digoxin or captopril in the captopril and digoxin groups, respectively. The trial had to be terminated prematurely owing to the difficulty in finding candidates free of angiotensin-converting enzyme (ACE)-inhibitor treatment. Baseline patient characteristics were similar in both groups. From the clinical point of view, only the 48-month mortality was relevantly lower (20.9 vs. 31.9%, respectively) among patients treated with captopril than that in those receiving digoxin (log rank test, p = 0.07). No statistically or clinically relevant differences were found in other end points or adverse effects. The results suggest but do not confirm the hypothesis that captopril treatment in mild to moderate heart failure might provide better long-term survival than digoxin.

Aged↗
PubMed1999

Production and characterization of an antibody specific for a novel protein serine/threonine kinase, MPK38, highly expressed in hematopoietic cells.

We report an antibody that selectively recognizes MPK38, a new protein serine/threonine kinase closely related to the SNF1 serine/threonine kinase family. This antibody recognized a region of the N-terminal kinase catalytic domain and part of the remaining C-terminal portion and was sensitive enough to detect a 72-kDa recombinant MPK38 in insect cells by Western blotting. Immunoblot analysis showed that the recombinant MPK38 was expressed in a time-dependent manner and reached a maximum after 48 h postinfection. In addition, the immune complex kinase assay revealed that the recombinant and endogenous MPK38 protein autophosphorylated in vitro. Phosphoamino acid analysis of autophosphorylated MPK38 protein showed that the phosphorylation was exclusively on serine and threonine residues, suggesting that MPK38 is a protein serine/threonine kinase. Thus, this antibody could be helpful for elucidating the biological functions of MPK38 in the MPK38-expressing cells.

Animals↗
PubMed1998

Efficacy of radiotherapy for malignant gliomas in elderly patients.

PURPOSE: Age above 65 years is a strong negative prognostic factor for survival in patients with malignant gliomas (MG) treated with radiotherapy (RT) and its value has been questioned. We analyzed the effect of RT on the survival of elderly patients with malignant gliomas. METHODS AND MATERIALS: We examined 85 consecutive elderly patients with a histological diagnosis of MG. Age ranged from 65 to 81 years (median 70 years). Glioblastoma multiforme (GBM) was diagnosed in 64 patients (75.3%). Surgical treatment included needle biopsy in 32 patients (37.6%). Median postoperative Karnofsky Performance Status (KPS) was 60 (range: 30-100). Survival probability was estimated using Kaplan-Meier method and compared with the log-rank test. Crude and adjusted hazard ratios (HR) were calculated using Cox's regression models. RESULTS: Median survival time for all patients was 18.1 weeks. In multivariate analysis, RT was the only independent prognostic variable for survival (HR: 9.1 [95% CI: 4.5-18.7]). Forty-two patients did not start RT mostly due to low KPS (<50). The median survival of the 43 patients who started RT was 45 weeks. In these patients, Cox multivariate analysis indicated that age was independently associated with prolonged survival (HR: 2.85 [95% CI 1.31-6.19]). Median survival of patients age 70 years and younger was 55 weeks compared with 34 weeks for patients older than 70 years. CONCLUSIONS: The overall survival for elderly patients with MG is poor. RT seems to improve survival in patients up to 70 years, but in older patients treated with RT the survival is significantly shorter.

Aged↗
PubMed1998

[Prescription habits in a primary health care district: approach to an indication-prescription study].

OBJECTIVE: To analyse the profile of medical prescription and prescription habits in the most common illnesses in a Primary Health Care district. DESIGN: Descriptive crossover study. SETTING: Algeciras-La Línea (Cádiz) Primary Care district. MEASUREMENTS AND MAIN RESULTS: A randomised sample of clinical histories stratified by months was selected. This included 338 Paediatrics cases (< 8 years old) and 665 general medical cases (> 8). The therapeutic groups most commonly prescribed for the children were R (45.7%) and J (27.1%) The therapeutic groups most used among the > 8 group were C (17.9%), R (14.8%), N (14.7%) and A (14.3%). Hypertension was the most common chronic pathology in this group (8.9%), treated most often by ACEIs (44.9%). CONCLUSIONS: 1) In our ambit, the most widespread pathology signified the greatest consumption of therapeutic groups. 2) The indication-prescription analysis detected prescription habits that need to be watched: the use of antibiotics and expectorants/mucolytics in ARI and the use of fixed-dose combinations which are hard to justify. Prescription habits in Hypertension treatment and Hyperlipidaemia also merit a consensus analysis.

Adolescent↗
PubMed1998

MPK38 expression is upregulated in immature T cells activated by concanavalin A.

We have previously identified a cDNA clone from a murine teratocarcinoma PCC4 cDNA library, which we have termed MPK38 for murine protein kinase 38. MPK38 is a new member of the SNF1 serine/threonine kinase family. To understand the role of the MPK38 in thymocytes, we have investigated the level of MPK38 expression by Northern blot analysis. Interestingly, incubation of thymocytes at 37 degrees C resulted in the loss of the MPK38 transcript, however the transcript could be reinduced by treatment with Con A or PHA, but not with PMA and growth factors such as IL-2, IL-7, TGF-beta, TNF-alpha, and EGF. In addition, stimulation of mature T cells from the spleen with Con A failed to reinduce the MPK38 transcript, indicating a developmental regulation of MPK38 expression, whereas non-T cell populations significantly reinduced the transcript. These results suggest that MPK38 may play a functional role as one of the signal regulators in early T cell activation and, potentially, certain lineages of hematopoietic cell activation induced by Con A.

Animals↗
PubMed1998

Chronic immobilization stress appears to increase the role of dopamine in the control of active behaviour in the forced swimming test.

Previously, we have demonstrated that chronic exposure to immobilization (IMO) did not modify the influence of catecholamines on active behaviour of rats in the holeboard, but clearly increased the role of these amines in the forced swimming test (FST). In the present experiment, it was studied whether or not chronic IMO altered the role of dopamine in the two tests. Adult male Sprague-Dawley rats were left either undisturbed or subjected daily to 2 h of IMO stress for 12 days. On the following day, half of the rats were administered saline and the others the dopamine antagonist haloperidol (0.5 mg/kg). Then the rats remained undisturbed in the animal room (controls) or were subjected to acute IMO for 2 h. Finally, all animals were exposed consecutively to the holeboard (4 min) and the FST (5 min). In non-chronically stressed rats, acute IMO depressed behaviour in the holeboard but not in the FST. In chronic IMO rats the inhibitory effect of acute IMO on holeboard activity was slightly reduced as compared to controls. Acute IMO increased struggling in rats previously exposed to chronic IMO but did not alter struggling in non-chronically stressed rats. Whereas the inhibition caused by haloperidol treatment in the active behaviour of rats in the holeboard was not altered by chronic IMO, the inhibitory effect of haloperidol in the active behaviour of rats in the FST was greater after chronic IMO, particularly in rats also subjected to acute IMO. These data suggest that chronic IMO stress potentiates the role of dopamine in a specific behavioural task such as the FST and adds support to the previously published data demonstrating enhanced behavioural and neurochemical responses to dopamine-related drugs after chronic stress.

Animals↗
PubMed1998

Association between giardiasis and allergy.

BACKGROUND: Previous studies have indicated that there may be an association between infection by the intestinal protozoan Giardia lamblia and the expression of allergic disease. OBJECT: We evaluated a group of children who attended the Outpatient Clinic of the Children's Hospital in Caracas, Venezuela, a group in which both allergic disease and giardiasis were common. METHODS: We performed feces examination and measured total and specific serum IgE (immunoglobulin E) in these children. RESULTS: We found that 70% of the children infected with G. lamblia presented symptoms of allergy, in contrast to 43% of the non-Giardia parasitized group (P <.05). In addition, the G. lamblia parasitized children showed significantly higher levels of total serum IgE (1194 IU/mL) than the non-Giardia group (822 IU/mL) (P <.005). Children infected with G. lamblia showed higher levels of specific serum IgE antibody against food allergens compared both with the non-parasitized group (P <.0001) and children infected with parasites other than Giardia (P <.05). In contrast, IgE responses against the house dust mite Dermatophagoides pteronyssinus were similar in all the groups studied. CONCLUSIONS: These results reveal a clear relationship between giardiasis and allergy, possibly because infection by this protozoon enhances sensitization towards food antigens, due to increased antigen penetration through damaged intestinal mucosa.

Antibodies, Protozoan↗
PubMed1998

Epidemiology of peptic ulcer disease in cirrhotic patients: role of Helicobacter pylori infection.

OBJECTIVE: The aim of this study was to investigate the clinical and epidemiological factors associated with the appearance of peptic ulcer in patients with cirrhosis and, in particular, the role of Helicobacter pylori infection. METHODS: A total of 201 of 220 consecutive patients included in a prospective study that aimed to evaluate the effect of dietary intervention on cirrhotic complications and survival underwent upper gastrointestinal endoscopy. At entry, an epidemiological and clinical questionnaire was completed and the presence of peptic ulcer disease or esophageal varices at endoscopy was prospectively collected. Sera were obtained and stored at -70 degrees C until analyzed, being tested afterward for Helicobacter pylori antibodies using a commercial ELISA kit. RESULTS: Eleven of 201 patients had borderline anti-Helicobacter pylori IgG titers and were excluded from further analysis. In the remaining 190 patients, point prevalence of peptic ulcer was 10.5% and lifetime prevalence 24.7%. Multivariate analysis selected male sex (OR 2.3; 95%CI 1.09-4.89) and Helicobacter pylori seropositivity (OR: 1.7, 95%CI 1.02-2.81) as the variables independently related to peptic ulcer disease. CONCLUSIONS: Male sex and seropositivity for Helicobacter pylori are the major risk factors for peptic ulcer in cirrhosis.

Female↗
PubMed1998

Helical CT versus CT arterial portography in the detection of hepatic metastasis of colorectal carcinoma.

OBJECTIVE: The study is a prospective comparison of helical CT with nonhelical CT arterial portography (CTAP) in the detection of liver metastases from colorectal carcinoma, using surgical and histologic findings as the gold standard. SUBJECTS AND METHODS: Thirty-five patients with colorectal carcinoma and suspected liver metastases were prospectively examined with helical CT and CTAP before surgery. In nine cases, surgery was not performed. In the remaining 26 patients, imaging results were correlated with surgical and pathologic findings. Three radiologists prospectively assessed metastatic involvement with both techniques. The results were compared with pathologic and surgical findings on a lesion-by-lesion basis. In a second phase, three radiologists not directly concerned in the design of the study independently assessed metastatic involvement of the liver as revealed on helical CT and CTAP on a segment-by-segment basis with a five-level scale of confidence. Results were analyzed by receiver operating characteristic methods. RESULTS: The results of the histologic study disclosed 50 metastatic lesions. Helical CT had a sensitivity of 76% (38/50) and a positive predictive value of 90%. CTAP had a sensitivity of 74% (37/50) and positive predictive value of 69%. Receiver operating characteristic analysis revealed a greater area under the curve (Az index), 0.96, for helical CT than for CTAP (0.86). Differences were statistically significant (p < .001). CONCLUSION: Helical CT is superior to nonhelical CTAP in the detection of hepatic metastases from colorectal carcinoma.

Adult↗
PubMed1998

[The improvement of echocardiographic assessment of the left ventricle by the use of perflenapent and harmonic imaging].

Contrast echocardiography and harmonic imaging (HI) are promising new modalities applied in order to obtain improved visualisation of the left ventricle. Perflenapent (EchoGen, Abbott) is a new generation echocardiographic contrast agent that crosses the pulmonary capillary bed and produces long-term ventricle opacification. Our aim was to assess the left ventricle endocardial visualisation after perflenapent infusion and HI technique. We studied a pilot group of 10 patients (mean age 52.5 +/- 7.6, mean weight 76.9 +/- 10.1 kg, one female) with previously obtained sub-optimal non-contrast echocardiograms. Perflenapent was injected intravenously at dosis 0.05 ml/kg. Echocardiography was performed before perflenapent injection and during the time between injection and LV image disappearance. Images were assessed using four-point scale, 0 standing for the poorest and 3 for excellent visualisation. Perflenapent produced full chamber opacification in all pts. Contrast effect was observed for 550-15824 sec and myocardial enhancement was seen for 176-2116 sec after i.v. administration. After perflenapent administration, endocardial border was significantly better visible than before (1.9 +/- 0.57 vs. 2.9 +/- 0.31, p < 0.001). No hemodynamic effects were noted, as assessed by oxygen saturation, blood pleasure and heart rate. A mild, transient somnolence was seen in one pt. Perflenapent improved left ventricular function diagnostic capabilities, and provided enhanced visualisation of the myocardium.

Adult↗
PubMed1998

[Correction of social inequalities in health: reform of primary health care as a strategy].

OBJECTIVES: To evaluate the impact of a policy to define priorities for the reform of primary health care services among small areas according to health and social indicators. DESIGN: Qualitative study of the changes in the provision of primary health care services after a priority setting exercise based in social and a health indicators. SETTING: The city of Barcelona (Catalonia, Spain). PARTICIPANTS: The 66 basic health areas in which the city is divided for health care planning. INTERVENTION: Areas are ranked according to their health and social indicators, giving greater priority to those areas with unfavorable indicators for the development of the reform of primary health care services and a associated allocation of resources. RESULTS: Although at first new investments were determined by preexisting processes based in opportunity criteria, clear changes are observed. Three years after, there are improvements in the provision for services in all priority areas, or they are in the midst of change. CONCLUSIONS: In a context of tightening resources and of resistance to change, it is possible to introduce objective criteria to set priorities to improve primary health care services selectively in areas with most unfavorable indicators. This process has the capacity to overrun obstacles and resistances.

Health Care Reform↗
PubMed1998

Rat liver genesine: a biochemical approach.

Genesine, the naked autoglucosylating protein involved in glycogen biosynthesis, was partially purified from rat liver and some of its biochemical properties were characterized. Its activity was strongly activated by Mn2+ and two-pH optimums were obtained. UDP-14C-Glc was the preferred glucosyl donor substrate, but also UDP-14C-Xyl was. It was additionally found that more than one glucose was transferred to the protein or to that alpha1,4 glucan already linked to the protein from UDP-Glc. Glucose, maltose, xylose and UDP were inhibitors of genesine activity.

Animals↗