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Biomedical subjects

M Núñez

Publications and source records attributed to M Núñez.

At least 19 recordsLinked to original sources
PubMed2006

Health-related quality of life and costs in patients with osteoarthritis on waiting list for total knee replacement.

OBJECTIVES: To determine: (1) health-related quality of life (HRQL) in patients with severe osteoarthritis (OA) on a waiting list (WL) for total knee replacement (TKR) and to compare it with general Spanish reference population values (RPVs); (2) the influence of sociodemographic and clinical variables on HRQL dimensions and (3) the use and cost of resources related to knee OA. METHODS: Cross-sectional study. HRQL was measured by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Medical Outcomes Study 36 Item Short Form Health Survey (SF-36) questionnaires. Sociodemographic and disease characteristics, body mass index, pharmacological treatment and the cost and use of economic resources related to knee OA during the 6-months previous to baseline were recorded. Relationships were analyzed using linear regression models. RESULTS: One hundred consecutive outpatients (71 female, mean age 71+/-6.89 years, mean disease duration 11.84+/-10.52 years) were included. Patients showed worse HRQL measured by SF-36 than the reference population, mainly in physical function, physical role and bodily pain dimensions (P<0.05). A low number of visits to physicians were recorded (mean 0.62+/-1.04). Total mean direct medical costs were 200.24 euro (95%CI 167.08-233.40) and total mean direct non-medical costs were 1234.87 euro (95%CI 812.74-1657.00). CONCLUSIONS: The HRQL of patients on a WL is worse than that of the reference population. The main costs of these patients were on non-medical resources, mainly due to functional limitations and loss of autonomy. The results suggest little compliance with knee OA management guidelines.

Aged↗
PubMed2005

Comparison of three different staining methods for the assessment of epididymal red deer sperm morphometry by computerized analysis with ISAS.

When collection of ejaculated sperm samples is not possible, as is the case with wild species, the epididymides of sacrificed wild males become the only possible source of spermatozoa. Mature cauda epididymal spermatozoa display characteristics similar to those of ejaculated sperm cells. The present work proposes a sperm staining technique suitable for the morphometric evaluation of red deer epididymal sperm using a new computerized system. Epididymides from wild animals were extracted no later than 2h post mortem. After epididymal sectioning, sperm samples were collected, cooled to and equilibrated at 5 degrees C, and frozen in liquid nitrogen. Before staining, sperm samples were thawed for 20s at 37 degrees C, and used for the preparation of slides. Three different sperm stains were tested: Hemacolor, Diff-Quik, and Harris' Hematoxylin. Morphometric analyses of sperm samples were performed using the morphologic module of the ISAS. Two hundred spermatozoa per sample and stain were captured at random and analyzed. Sperm morphometric values were significantly affected by the staining technique used. Moreover, significant differences were observed between animals. In our study, Diff-Quik could be considered to be the best sperm staining method, as it provided the highest percentage of well automatically analyzed cells by the ISAS, and discriminates better between animals. This sperm staining technique also proved to be a useful method for characterizing and discriminating between sperm samples of different animals.

Animals↗
PubMed2005

Effect of solid storage at 15 degrees C on the subsequent motility and fertility of rabbit semen.

We conducted two studies to improve preservation of rabbit semen. The objective of the first study was determine whether a glucose- and fructose-based extender with two different amounts of gelatin would solidify at 15 degrees C, and to evaluate the influence of gelatin supplementation on sperm motility parameters after storing semen up to 10 days at 15 degrees C. The fertility of rabbit semen diluted in the best gelatin-supplemented extender established in Study 1 and stored for up to 5 days was evaluated in the second study. In Study 1, semen was collected with an artificial vagina from 40 bucks. Each ejaculate was diluted to (80-100) x 10(6) spermatozoa/mL (1:3, semen/extender) at 37 degrees C in one of the three following glucose- and fructose-based extenders: control (standard liquid extender), semi-gel or gel (0.7 or 1.4 g gelatin in 100 mL extender, respectively). Pools of semen were allocated among 0.6 mL plastic artificial insemination (AI) guns. Thirty (10 per extender group) AI doses were immediately analyzed (0 h) and the remainder stored in a refrigerator (15 degrees C) for 12, 24, 36, 48, 72, 96, or 240 h. All doses with gelatin extenders solidified at 15 degrees C. Semen samples, prewarmed to 37 degrees C, were evaluated with a computer-assisted sperm analysis (CASA) system. The percentage of motile cells was significantly lower using the liquid compared to the gel extenders during semen storage from 0 to 96 h. Although significance was lost, these differences persisted after 240 h of storage. Motility of spermatozoa in the semi-gel extender was intermediate between that of liquid and gel extender throughout the study. Study 2 was performed on 1250 multiparous lactating does. Five homogeneous groups of 250 does previously synchronized were inseminated using semen previously stored for 120, 96, 72, 48 or 24 h, respectively. Rabbit does receiving 24 h-stored semen (diluted with the control extender used in Study 1) served as controls. The remaining females received seminal doses supplemented with 1.4 g/100mL gelatin (gel extender used in Study 1). Kindling rates for rabbit does inseminated with gelatin-supplemented (solid) semen doses stored for 48 h (88%) or 72 h (83%) were similar to those recorded for liquid controls stored for 24 h (81%), whereas rates significantly decreased when the semen was solid and stored for 96 h (64%) or 120 h (60%) before AI. In conclusion, rabbit spermatozoa were effectively stored in the solid state at 15 degrees C, with fertility preserved for up to 5 days. Solid storage of rabbit semen would facilitate commercial distribution.

Animals↗
PubMed2005

Clinical benefit of interventions driven by therapeutic drug monitoring.

BACKGROUND: Adequate plasma concentrations of antiretroviral drugs are key to achieving and maintaining long-term suppression of HIV replication. Multiple factors may influence drug levels, causing increases or reductions that may, respectively, result in toxicity or virological failure. Therapeutic drug monitoring (TDM) might help to detect and correct such abnormalities. OBJECTIVE: To evaluate the usefulness of TDM in the care of HIV-infected patients in an out-patient clinical setting. METHOD: S All the requests for TDM of protease inhibitors (PIs) and nonnucleoside reverse transcriptase inhibitors (NNRTIs) for patients attending our HIV out-patient clinic from October 2000 to August 2003 were analysed. Blood samples were collected before the morning dose. Drug concentrations were measured by high performance liquid chromatography by ultraviolet waves (HPLC-UV). R:A total of 151 requests from 137 patients were assessed. The reasons for requesting TDM were drug toxicity (59%), virological failure (39%) and possible drug interactions (2%). NNRTI levels were more often requested because of toxicity, while PI levels were more often requested because of virological failure. Elevated drug levels were confirmed in 36% of patients with suspected drug toxicity, while subtherapeutic levels were found in 37% of patients failing virologically. Based on the results of TDM, dose modifications were made in 37% of patients, allowing correction of such abnormalities in 80% of cases. Moreover, adequate plasma concentrations were confirmed in 79% of patients whose levels were assessed again. CONCLUSIONS: Therapeutic drug monitoring may be a useful tool to identify toxic levels of NNRTI and subtherapeutic concentrations of PI. Dose adjustments following TDM may ameliorate drug-related toxicities or improve virological response rates.

Adult↗
PubMed2004

Knee osteoarthritis: interpretation variability of radiological signs.

The aim of this study was (1) to determine the variability in detecting radiological signs of knee osteoarthritis (OA) between an orthopaedics specialist, a fourth-year resident in the speciality and a recently qualified doctor and (2) to determine which of the existing criteria show the greatest variability when used by the three participants to detect the degree of evolution of the pathology. This observational study included radiographs of 95 patients with knee pain. Osteophytes, narrowing of joint space (excluding inter-osteophyte bridges) subchondral sclerosis, subchondral cysts, collapse of the central joint cortical bone and lateral deformity, according to the criteria of Kellgren and Lawrence, modified by Kallman et al. were evaluated. Anteroposterior radiographs were used. Knees that had undergone previous surgery were excluded. Cohen's kappa index was used to calculate the degree of agreement between observers. The concordance analysis showed a low level of agreement among the three observers of the radiological variables with a maximum of 50% in some parameters. The authors discuss the possible causes of this low level of agreement. The low degree of agreement of 50% among the three observers is in line with previous reports and suggests that better training of observers is necessary and that the use of any classification is problematic.

Aged↗
PubMed2004

Consensus conference on chronic viral hepatitis and HIV infection: updated Spanish recommendations.

Chronic hepatitis B and C represent a leading cause of morbidity and mortality among human immunodeficiency virus (HIV)-infected patients worldwide. New treatment options against both hepatitis B (HBV) and C (HCV) viruses have prompted us to update previous recommendations for the management of coinfected individuals. Fifteen topics (nine related to HCV, five to HBV and one to both viruses) were selected for this purpose. A panel of Spanish experts in the field was invited to review these areas and propose specific recommendations, which were scored according to the Infectious Disease Society of America (IDSA) grading system. These guidelines represent a comprehensive and updated overview on the management of hepatitis B and C in HIV-infected patients.

Anti-HIV Agents↗
PubMed2003

[Strongyloides stercoralis in the south of Galicia].

Strongyloides stercoralis is the only parasite which can produce a chronic illness in humans, being through autoinfection. This nematode can also provoke death when patient's immunologic state deteriorates producing a massive hyper infection. The first patient with strongyloidiasis who has always lived in the Galician South area is described. The clinical picture consisted of unspecific cutaneous lesions and abdominal pain with severe peripheral eosinophilia (> 20,000/ml. The diagnosis was carried out observing the larvae in the fecal examination and was confirmed with a culture. Treatment with albendazole failed and the healing was reached with ivermectin. We must consider the possibility of strongyloidiasis because misdiagnosing these patients as eosinophilic gastroenteritis there would be a higher risk of hyperinfection if they are treated with corticosteroids.

Adult↗
PubMed2002

Predictive value of (99m)Tc sestamibi scintigraphy in the evaluation of doxorubicin based chemotherapy response in patients with advanced breast cancer.

Resistance to doxorubicin based chemotherapy is a major therapeutic problem limiting advanced breast cancer treatment. 99mTc hexakis-2-methoxyisobutylisonitrile ((99m)Tc-MIBI) has been reported to be extruded from tumour cells by the P-glycoprotein and multidrug resistance protein encoded by MDR1 and MRP1 genes, respectively. These proteins are involved in the cellular efflux of several chemotherapeutic agents including doxorubicin. The aim of this study was to investigate the clinical value of a standard (99m)Tc-MIBI scintimammography technique in the prediction of response to chemotherapy in advanced breast cancer patients. Fifty-six lesions from 33 female patients with locally advanced (n=27) or recurrent breast cancer (n=6) were included in the study. MIBI scintigraphy was performed 2-8 days prior to chemotherapy (FAC regimen). Images were acquired 10 min and 1 h post-injection of 740-1110 MBq of (99m)Tc-MIBI. Tumour-to-normal background tissue uptake ratios were calculated on each lesion in the early (T/B(e)) and delayed phase of the study (T/B(d)). Both T/B(e) and T/B(d) ratios were significantly higher (P<0.0001) in responders (n=43) than nonresponders (n=13). Diagnostic values of (99m)Tc-MIBI in the prediction of chemotherapy response were evaluated using the arbitrary cut-off values of 1.5 for T/B(e) and 1.4 forT/B(d). Sensitivity, specificity, positive and negative predictive values were 88.4%, 92.3%, 97.4%, 70.6%; and 90.7%, 100.0%, 100.0%, 76.6%, for T/B(e) and T/B(d), respectively. We conclude that (99m)Tc-MIBI scintigraphy may be a clinically valuable tool for guiding chemotherapy in advanced breast cancer patients.

Adult↗
PubMed2001

[Rate and risk factors of liver toxicity in patients receiving antiretroviral therapy].

BACKGROUND: The benefit of highly active antiretroviral therapy (HAART) may be limited by the development of liver toxicity. The prevalence and risk factors of this complication using different antiretroviral drug combinations are not well known. PATIENTS AND METHOD: Clinical charts of HIV-infected patients, previously naive for antiretroviral drugs, starting HAART between January 1997 and January 2000 were reviewed. Liver toxicity was scored according to increases in liver enzymes. RESULTS: HIV infection had been acquired by intravenous drug use in 36 (40%) of 91 subjects recruited in the study. The rest had been infected through homosexual (38%) or heterosexual contact (22%). Overall, 43 patients (47%) were coinfected with hepatitis C (42%) and/or B (8%) viruses. Antiretroviral therapy included protease inhibitors (PI) plus two nucleosides in 48 individuals and non-nucleosides in 50. Baseline characteristics were similar across the different treatment groups. Liver toxicity was recorded in 30 (31%) subjects, and it was severe in 10 (11%). Cytolysis was the predominant pattern (28), while only one case of cholestasis and one with a mixed pattern were recorded. Coinfection with hepatitis B and/or C viruses was associated with liver toxicity (RR: 10.36; 95% CI, 1.38-77.56; p = 0.03) as was a high alcohol intake (RR: 3.35; 95% CI, 2.43-4.62; p = 0.01). No differences in the rate of hepatotoxicity were found when comparing PI and non-nucleoside containing regimens. The development of isolated hyperbilirubinemia (27%) was strongly associated with the use of indinavir (RR: 3.61; 95% CI, 1.81-7.21; p < 0.001). CONCLUSIONS: Liver toxicity occurs in about one third of HIV-infected patients after initiating HAART, regardless of the drugs used, yet it is commonly mild and transient. A high alcohol intake and a coinfection with HCV/HBV constitute the most important predictive factors.

Adult↗
PubMed2001

Risk factors for severe hepatic injury after introduction of highly active antiretroviral therapy.

OBJECTIVES: Treatment of HIV infection with highly antiretroviral therapy (HAART) may be limited by liver toxicity. Its incidence and risk factors are not well known. PATIENTS AND METHODS: Retrospective chart review. Naive patients beginning HAART between January 1997 and January 2000. Severe transaminase elevation was defined as fivefold or higher rise over upper normal limits, or as > or =3.5-fold rise above abnormal baseline values. RESULTS: Of 222 study subjects, 38%, 5%, and 2% were coinfected with hepatitis C virus (HCV), hepatitis B virus, and hepatitis D virus, respectively. Besides two nucleoside reverse transcriptase inhibitors (NRTIs), 96 patients received protease inhibitors (PIs), 90 received nonnucleoside reverse transcriptase inhibitors (NNRTIs), and 35 received a PI + NNRTI combination. Severe hepatic injury developed in 21 (9%): 10% PI, 9%, and 9% PI + NNRTI. Both univariate and multivariate analyses identified alcohol abuse, HCV coinfection, and older age as independent risk factors. Predictor variables in the final multivariate model were: alcohol abuse (risk ratio [RR], 5.87; 95% confidence interval [CI], 1.49-23.15; p =.01], positive HCV serology (RR, 3.99; 95% CI, 1.32-12.10; p =.01], and older age (RR, 1.11; 95% CI, 1.04-1.18; p = 0.001). CONCLUSIONS: Nearly 10% of study subjects who start HAART experience severe transaminase elevation, irrespective of the treatment. Avoidance of alcohol abuse, especially in study subjects coinfected with HCV, will reduce the risk of hepatic injury after HAART. When possible, prior treatment for chronic HCV infection should be considered.

Adult↗
PubMed2001

Effect of alpha quenching on magnetic field size.

It is commonly assumed that the alpha effect of mean-field magnetohydrodynamics essentially stops acting wherever the mean-field size reaches a certain value. We show that if the mean velocity is approximately constant, the regions where the field reaches such a threshold tend to shrink in size or the field tends to become constant there. The rate of this process is also estimated.

Journal Article↗