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Biomedical subjects

M J Ferrer

Publications and source records attributed to M J Ferrer.

11 recordsLinked to original sources
PubMed2007

Influence of the type of pegylated interferon on the onset of depressive and neuropsychiatric symptoms in HIV-HCV coinfected patients.

This is a prospective observational comparative 48-week study to assess the impact of the different types of Peg-IFN on depressive and neuropsychiatric symptoms during treatment in HIV-HCV coinfected patients. Thirty-one patients treated with Peg-IFN alpha-2b 1.5 microg/kg/w plus ribavirine (RBV) (Peg-IFN alpha-2b Group) and 32 patients receiving Peg-IFN alpha-2a 180 microg/w plus RBV (Peg-IFN alpha-2a Group) were included. Depressive and neuropsychiatric symptoms, quality of life and adherence were assessed. Fifteen subjects (23%) discontinued therapy (p = 0.3, between groups). Overall, 37 patients presented mild to moderate depressive symptoms, 9 moderate to severe and 3 severe, without differences between groups. Patients in Peg-IFN alpha-2b reported higher fatigue and dizziness at weeks 12 (p < 0.05) and 24 (p < 0.05), and irritability and memory loss at week 24 (p < 0.05) with respect to Peg-IFN alpha-2a Group. At week 12, role functioning, general health perception, vitality, emotional role, mental health and the summary areas of physical health and mental health were lower in Peg-IFN alpha-2b Group (p < 0.05). The same was observed in physical functioning (p = 0.05) and role functioning, general health perception, emotional role and mental health (p < 0.001) at week 24. Three months after finishing treatment, no patient had depressive or neuropsychiatric symptoms, and quality of life improved. Antiretroviral adherence was low but adherence to anti-HCV therapy remained high in both groups. According to our data, Peg-IFN alpha-2a and Peg-IFN alpha-2b exert a similar impact on the overall rate of depressive symptoms, although patients treated with Peg-IFN alpha-2a experience less fatigue and fewer neuropsychiatric symptoms and a lower impairment in their physical and mental quality of life.

Adult↗
PubMed2003

Papillary squamous cell carcinoma of the oropharynx.

A case of papillary squamous cell carcinoma of the oropharynx is reported. The lesion was located in the base of the tongue and grossly presented a characteristic finger-like pattern of growth. The clinicopathological profile of the neoplasm is presented and the differential diagnosis with other exophytic squamous cell carcinomas is discussed.

Adult↗
PubMed2001

Psychological impact of structured treatment interruptions in patients with prolonged undetectable HIV-1 viral loads.

Structured treatment interruption strategies may help overcome problems of highly active antiretroviral therapy, but might also represent a cause of stress. We present data that indicate a psychological benefit from structured treatment interruption. Although some disturbances appear at the resumption of therapy, no definitive problems are found that preclude such therapeutic approaches from a psychological perspective. However, a close follow-up of patients during interruption periods is advisable to avoid difficulties reported at treatment resumption presenting a risk to patients' health.

Antiretroviral Therapy, Highly Active↗
PubMed2000

Prospective randomized two-Arm controlled study to determine the efficacy of a specific intervention to improve long-term adherence to highly active antiretroviral therapy.

BACKGROUND: Nearly perfect compliance seems to be indispensable to obtain the maximum benefit from highly active antiretroviral therapy (HAART). Interventions to ensure a high level of adherence during a relatively long-term period of therapy are necessary. METHODS: This is a prospective, randomized, two-arm controlled study including patients starting their first-or second-line HAART who were randomized to receive psychoeducative intervention to implement adherence (experimental group [EG]) or a usual medical follow-up (control group [CG]). We aimed to study the efficacy of a psychoeducative intervention to ensure long-term adherence to HAART, its relation with the virologic efficacy of treatment, and to determine the variables related to long-term adherence. Visits were made at weeks 0, 4, 24, and 48 for data collection. Self-reported adherence was registered at each visit and its veracity was tested by randomized blood analyses performed without previous warning to 40% of patients. Appropriate adherence was defined as the consumption of >/=95% of medication prescribed. Statistical analyses were performed both by the as treated (AT) and the intention to treat missing = failure (ITT) methods. RESULTS: In all, 116 patients were included. At week 48, 94% of patients in the EG versus 69% controls achieved adherence >/=95% (p =.008); 89% of patients in the EG versus 66% controls had HIV-1 RNA levels <400 copies/ml (p =.026). Overall, 85% of patients with adherence >/=95% but only 45% of those with adherence <95% had viral load (VL) <400 copies/ml (p =. 008). In multivariate analysis, variables significantly related to adherence were having received a psychoeducative intervention (odds ratio [OR], 6.58; p =.04), poor effort to take medication (OR, 5.38; p =.03), and high self-perceived capacity to follow the regimen (OR, 13.76; p =.04). Self-reported adherence and drug plasma levels coincided in 93% of cases. However, differences in adherence did not reach statistical significance in the ITT analysis although a clear tendency toward benefit was observed in EG. CONCLUSIONS: Specific and maintained psychoeducative interventions based on excellence on clinical practice are useful to keep high levels of adherence as well as high levels of viral suppression. There is a clear relation between high adherence levels and virologic success. Assessment of certain specific variables related to adherence may be helpful to monitor patient's compliance in the clinical setting.

Adult↗
PubMed1997

Intrathecal morphine for postoperative analgesia following repair of frontal encephaloceles in children: comparison with intermittent, on-demand dosing of nalbuphine.

STUDY OBJECTIVE: To determine the efficacy of lumbar intrathecal (i.t.) morphine in a dose of 0.02 mg/kg in providing analgesia following repair of frontal encephaloceles. DESIGN: Prospective, open-label investigation of i.t. morphine with secondary comparison to a retrospective cohort. SETTING: Metropolitan hospital in the Philippines. PATIENTS: 24 ASA physical status I and II children undergoing frontal encephalocele repair. INTERVENTIONS: Following induction of general anesthesia. I.t. morphine (Group 1) was administered via single-shot technique or through a lumbar i.t. drain placed for cerebrospinal fluid drainage during the surgical procedure. Postoperative analgesia was assessed by visual analog score in patients greater than 5 years of age or a behavioral score in patients less than 5 years of age. The retrospective cohort received postoperative analgesia with intermittent doses of intravenous nalbuphine (Group 2). MEASUREMENTS AND MAIN RESULTS: Group 1 had decreased postoperative analgesic requirements, decreased intraoperative inhalational anesthetic requirements, and a longer time to the first request for postoperative analgesia than Group 2. The time to the first request for postoperative analgesia was 16.0 +/- 9.1 hours in Group 1 and 1.6 +/- 1.2 hours in Group 2 (p < 0.0001). Six of 12 patients in Group 1 required no analgesic drugs during the first 24 postoperative hours while all 12 patients in Group 2 (p = 0.02) did require analgesic drugs during this period. The patients in Group 1 who did not require supplemental analgesic drugs maintained pain scores of 2 or less throughout the first 24 postoperative hours. CONCLUSION: Lumbar IT morphine provides effective analgesia following repair of frontal encephaloceles in children and adolescents.

Analgesics, Opioid↗
PubMed1994

[Mechanical ventilation-associated pneumonia and the prevention of stress ulcer. A randomized clinical trial of antacids and ranitidine versus sucralfate].

BACKGROUND: To study two groups of patients intubated with different prophylaxis of stress gastric ulcer in a prospective randomized trial. The differential effect on gastric pH, gastric colonization and the incidence of pneumonia associated to mechanical ventilation (PMV) were analyzed. METHODS: A prospective randomized study was carried out in two groups of patients: 1) prophylaxis with antacids and H2 blockers (AA+H2) and 2) prophylaxis with sucralfate. Intubated patients without initial respiratory infection were included in the protocol. Periodically gastric aspirations were collected measuring gastric pH and performing semi-quantitative cultures. When pneumonia was suspected bronchial brushing was carried out with telescoped catheter (BBTC) and quantitative culture. RESULTS: Fifty-one patients were studied (n = 51), distributed into 25 in the AA+H2 group and 26 in the sucralfate group. In the first group mean pH was higher (5.3 +/- 1.7) than in the sucralfate group (3.2 +/- 2.1) (p = 0.006). Nosocomial pneumonia (NP) was suspected on 25 occasions: 20 patients were positive for NP, 11 in the AA+H2 group and nine in the sucralfate group with no significant differences being observed. S. aureus, S. pneumoniae and H. influenzae (n = 14) were the etiology of predominant PMV. The global mortality of the group was of 22%. CONCLUSIONS: The prophylaxis of stress ulcers in intubated patients treated with antacids and ranitidine provoked higher gastric pH and an increase in gastric colonization in comparison to that observed with sucralfate. No significant differences were observed in the frequency of pneumonia by PMV diagnosed by BBTC.

Adult↗
PubMed1991

Bilateral infraorbital block with 0.5% bupivacaine as post-operative analgesia following cheiloplasty in children.

Various studies have shown that bupivacaine nerve blocks provide prolonged post-operative analgesia. We studied the efficacy of a 0.5% bupivacaine infraorbital nerve block as post-operative analgesia in a random, prospective, double blind manner in children undergoing cleft lip repair. Following the induction of anesthesia with ketamine 2-4 mg/kg im, 60 patients, aged 2-13 years, ASA I and II were equally divided: Group A received 1-1.5 ml bupivacaine, 0.5% with 1:200,000 epinephrine; Group B received 1-1.5 ml saline injected into the vicinity of the infraorbital foramina. In every patient, the surgeon infiltrated the lip with 4-7 ml of 1% lidocaine with 1:100,000 epinephrine for both anesthesia and hemostasis. Post-operative evaluations were completed after 4, 8, and 12 to 24 hours and were based on a visual analogue scale for pain. Similarly, the nurses and the parents also evaluated post-operative discomfort using specific criteria. All the observers were kept unaware of the solutions used for the block. The results showed that Group A was pain free for a mean duration of 19.4 +/- 5.06 (SD) hours in contrast to 11.7 +/- 6.19 hours for Group B, (p less than 0.001). Group A required no other analgesic whereas a total of 17 patients in Group B required analgesic medication starting at four hours post-operatively, (p less than 0.001). Both the nurses and the parents confirmed that those who received infraorbital block were more comfortable than those who did not. One-way analysis of variance indicates that the mean scores for both groups differs significantly at all levels of comparison, (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Bupivacaine↗
PubMed1988

Enhancement of adriamycin antitumor activity by its binding with an intracellular sustained-release form, polymethacrylate nanospheres, in U-937 cells.

We investigated the antitumor activity of Adriamycin on a monocytic-like cancer cell line U-937 after its binding on polymethacrylate nanospheres (diameter, 270-350 nm). Compared to free Adramycin (F-ADR), nanosphere-bound Adriamycin (B-ADR) exhibits a 3-fold enhancement of cytotoxicity, as determined by cell growth inhibition and DNA synthesis, after continuous exposure to 0.02 and 0.04 microgram/ml. The 90% growth inhibition concentration was 0.051 microgram/ml for F-ADR and was 0.018 microgram/ml for B-ADR (P less than 0.001). Furthermore, the nanosphere densities per cell play an important role since for the same drug concentration the higher the density increases, the better the activity is. Indeed, after 4 days of incubation in a medium containing 160 nanospheres at 0.5 fg/cell, the cell counts were 62.8 +/- 12.8% (SD) of the initial inoculum and they were only 16.1 +/- 0.1% after incubation in a medium containing 800 nanospheres at 0.1 fg/cell (P less than 0.001). A comparable enhancement of activity regarding the nanosphere densities was observed after a 24-h exposure to 0.02 and 0.05 microgram/ml. Short-term uptake studies showed that B-ADR accumulation was higher with B-ADR than with F-ADR. In addition, the efflux kinetics was modified. For cells exposed to F-ADR for 4 h, the efflux half-life was 23.7 +/- 7.7 h and the area to infinity under the efflux curve was 8.6 +/- 2.8 micrograms/mg protein x h-1. For cells exposed to B-ADR, the efflux half-life increased to 85.9 +/- 19.2 h and the area to infinity under the efflux curve to 29.6 +/- 6.6 micrograms/mg protein x h-1 (P less than 0.001). Electron transmission microscopy and previous findings have revealed that B-ADR was well internalized into cells. Our data support the hypothesis that B-ADR acts as an intracellular drug release complex after endocytosis. The findings regarding the number of nanospheres per cell and dose-effect relationships are consistent with mechanisms of drug actions extending to membrane domains.

Cell Compartmentation↗
PubMed1979

[Radio-immunometric determination of the ferritin for evaluation of the iron storage pool (author's transl)].

Seventy-three patients with several haematological diseases have been studied with radio-iron-kinetic, cyto-chemical measurement of iron in the bone marrow, and radio-immunometric determination of the ferritin in the serum. This method gives results which correlate significantly with other methods which evaluate the iron storage pool, in normal or iron-deficient patients. In some cases, an excess of serum ferritin, contrasting with normal serum iron, is confirmed by cytochemical and/or Fe-kinetic studies. In myeloproliferative diseases however, secretion of ferritin by immature cells may induce an excess of serum ferritin. In such cases, the dosage of ferritinaemia cannot be considered as an index of the iron storage pool. Future development of specific dosage of isoferritins could enable to measure the true iron stores, as well as to give an index estimating the evolution of the abnormal cell population.

Bone Marrow↗
PubMedDate not supplied

A lactobionate-based extracellular-type solution for donor heart preservation.

The University of Wisconsin solution, which contains the impermeant lactobionate and has an intracellular-type electrolyte composition, has been shown to improve donor heart preservation. Because a deleterious effect of the intracellular-type solutions has been reported, we evaluated a new lactobionate-based extracellular-type solution, by comparing it with University of Wisconsin solution and a crystalloid cardioplegic solution in 45 rabbit hearts. Hearts were arrested by infusion of these solutions and immersed in the same solution (lactobionate-based extracellular-type solution, University of Wisconsin solution) or in the lactated Ringer's solution (crystalloid cardioplegic solution) for 6 hours at 4 degrees C. A Langendorff circuit was used for reperfusion. Left ventricular compliance was better preserved with both lactobionate-based solutions than with the crystalloid cardioplegic solution. Adenosine triphosphate was best preserved with the lactobionate-based extracellular-type solution after arrest and after reperfusion, whereas reperfusion arrhythmias were less marked with the University of Wisconsin solution. These results suggest that lactobionate plays an important role in the preservation of ventricular compliance and that the lactobionate-based extracellular-type solution is preferable for adenosine triphosphate preservation. Further study will be required to assess the factors predisposing to reperfusion arrhythmias.

Adenine↗