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Biomedical subjects

M Olona

Publications and source records attributed to M Olona.

47 records · Page 3Linked to original sources
PubMed1992

Investigation of an outbreak of nosocomial infection due to a multiply drug-resistant strain of Pseudomonas aeruginosa.

A nosocomial outbreak of Pseudomonas aeruginosa infections which occurred in the Urology Service of a large city hospital was studied. A case-control methodology was used to analyse patients' characteristics and the main risk factors of all cases with a positive culture during the period between March 1987 and March 1988. The usefulness of factor analysis in the definition of a case was examined. There were 74 infections of which 35 (47.3%), had a nosocomial origin. The outbreak took place in December 1987, with a peak incidence of infections of 10.5%, compared with a 2.2% frequency during the preceding months (P less than 0.005). Six of the nine infections occurring in that month, were caused by strains resistant to ticarcillin and gentamicin. The epidemic cases had longer hospital stays than the non-epidemic cases (P less than 0.038) and occurred more frequently in a specific area of the hospital (P less than 0.001). The odds ratio for resistance to gentamicin was 15 (P less than 0.018) and that of resistance to ticarcillin, 127 (P less than 0.0001). Our results suggest that inaccurate case definitions may produce misleading conclusions. Factor analysis appears to be a useful analytical tool when defining a case.

Case-Control Studies↗
PubMed1992

[Can we do without bone gammagraphy in the staging of prostatic cancer?].

Correlation between findings on bone gammagraphy and PSA levels in 144 patients with untreated prostate cancer are analyzed. With prevalence of metastatic disease in 57.6% cases and considering the predictive cut value of metastasis to be 20 ng/ml, there were positive and negative predictive values of 64.9% and 73.9%, with a diagnostic confidence of 66.6%. We conclude that bone gammagraphy is essential for staging prostate cancer even in patients with PSA below 20 ng/ml.

Bone Neoplasms↗
PubMed1991

Uncomplicated first myocardial infarction: strategy for comprehensive prognostic studies.

To evaluate the prognostic role of combined cardiac studies (submaximal exercise test, thallium-201 scintigraphy, radionuclide exercise ventriculography, two-dimensional echocardiography, Holter monitoring and cardiac catheterization) in patients with a first acute myocardial infarction without complications during hospital admission, 115 consecutive patients aged less than 65 years were prospectively evaluated. The studies were carried out before hospital discharge and the patients were then clinically followed up for 12 months. During the follow-up period, 69 patients (60%) developed complications, which were severe in 23 (20%). Half of all complications and 70% of severe complications developed during the 1st follow-up month. Logistic regression analysis disclosed that the combination of studies with the highest predictive power for complications (probability of complications 99%) and severe complications (probability of severe complications 95%) was the association of exercise test + thallium-201 + echocardiogram. Four decision models (exercise test + echocardiography, exercise test + radionuclide ventriculography, thallium-201 scintigraphy + echocardiography, thallium-201 scintigraphy + radionuclide ventriculography) allowed the stratification of all patients in a particular risk category (high, intermediate or low). The best decision model was the association of thallium-201 scintigraphy + radionuclide ventriculography (probability of complications if both tests were positive 84%; probability of absence of severe complications if both tests were negative 88%), but there were no significant differences with the other models. Any association of a test detecting residual ischemia or functional capacity, or both (exercise test or thallium-201) and a test assessing ventricular function (echocardiography or radionuclide ventriculography) results in significant prognostic information in patients with an uncomplicated first acute myocardial infarction. Additional cardiac catheterization does not improve the predictive power of noninvasive studies, which should ideally be performed before hospital discharge because most complications develop during the 1st follow-up month.

Adult↗
PubMed1991

Drug-induced agranulocytosis: prognostic factors in a series of 168 episodes.

The prognostic value of 36 clinical and analytical parameters at diagnosis in patients with drug-induced agranulocytosis was analysed in an adult population. This multicentre, retrospective study examined possible prognostic factors by multiple logistic regression analysis in a series of 168 clinical episodes. The overall mortality was 16%. Renal insufficiency at diagnosis and the development of bacteraemia were associated with a poor prognosis. Advanced age, decreased leucocyte count, lymphocytopenia, bone marrow myeloid hypoplasia, increased percentage of bone marrow plasma cells and shock were found to be associated with a poor prognosis only in the univariate analysis. An independent analysis of the myeloid cellularity at diagnosis showed an inverse correlation with the time to recovery of the granulocyte counts (r = -0.43; P = 0.001). Our data indicate that despite some important clinical differences (higher incidence of infections of the oropharynx, shorter period of neutropenia and almost exclusive presence of gram-negative organisms), the infections complicating the treatment of cancer patients have the same prognostic features than those seen in patients with acute agranulocytosis. Therefore the established therapeutic guidelines for neutropenia after cancer chemotherapeutic agents are applicable to patients with acute agranulocytosis.

Acute Disease↗
PubMed1990

[Effect of smoking on hematologic parameters in healthy people].

In a cross-sectional study we investigated the effect of smoking on hematological parameters in 507 apparently healthy individuals. A positive association was found between smoking and leukocyte count, hemoglobin concentration, packed red cell volume, mean corpuscular volume, and mean corpuscular hemoglobin. By contrast, erythrocyte sedimentation rate was significantly lower in smokers. The number of red blood cells and mean corpuscular hemoglobin concentration were not associated with smoking. When health examinations are carried out, and whenever laboratory studies of healthy or ill persons are evaluated, the effect of smoking on hematological parameters should be considered.

Adult↗
PubMed1990

Lack of useful clinical predictors of response to splenectomy in patients with chronic idiopathic thrombocytopenic purpura.

We set out to identify clinical or analytical variables that might predict the response to splenectomy in patients with chronic idiopathic thrombocytopenic purpura (ITP). We retrospectively examined 138 mostly adult patients with chronic ITP, treated with splenectomy. Information was compiled from five Public Health Hospitals from a questionnaire and chart review. Sixty-one potentially prognostic variables were analysed by univariate and multivariate statistical methods. After multivariate analysis, age (relative risk = 1.02; CI 1-1.03) and a severity of the bleeding diathesis (relative risk = 1.6; CI 1.13-2.22) were independent prognostic factors for a sustained response to splenectomy. An independent analysis of the postsplenectomy counts showed that an early (days 1-3) thrombocyte count exceeding 156 x 10(9)/l cells increases the likelihood of a permanent unmaintained response. Our data indicate that the response to splenectomy in patients with chronic ITP cannot be adequately predicted on the basis of pre-splenectomy clinical or analytical variables.

Adult↗
PubMedDate not supplied

[National survey of preoperative management and patient selection in ambulatory surgery centers].

BACKGROUND: The objective of this study was to determine both the selection and preparation criteria in patients in various Spanish ambulatory surgery centers, as well as the impact of these criteria on their results. The results were compared according to the type of functional structure of the units (autonomous or integrated). MATERIAL AND METHODS: We performed a cross sectional, descriptive study through postal survey. The survey contained the following items: type of unit, surgical procedures, selection criteria, preoperative assessment and management, and qualitative and quantitative indexes of the activity performed in 2000. A total of 123 units were included with a response rate of 39%. RESULTS: The selection criteria showed a high degree of consensus. The outpatient anesthesia clinic was used for preoperative assessment by 97.9% of the units. Most units routinely requested preoperative tests (hemostasis and hemogram by 89%; biochemical parameters by 72.9%) and to a lesser extent chest X-ray (33.3%) and electrocardiogram (35.4%). The introduction of procedures for the management of coexisting diseases was scarce (25-64.6%). Units using the outpatient anesthesia clinic in all patients had a lower cancellation rate (1.5% vs 4.4%). Autonomous units were significantly more likely to accept patients with high surgical-anesthetic risk than integrated units. Autonomous units also showed a significantly lower number of admissions (1.2% vs 1.9%, p = 0.003), mean stay (240 min vs 367 min, p = 0.002), and recovery time (150 min vs 212 min, p = 0.001) than integrated units. No statistically significant differences were found in the remaining parameters. CONCLUSIONS: Scientifically based protocols for patient selection, preoperative assessment and perioperative management of distinct processes and for the rational use of laboratory tests should be more widely used. The need for an outpatient anesthesia clinic for preoperative assessment was notable. The results of our survey indicate that better results in performance indexes are achieved in autonomous ambulatory surgery units than in integrated units. Given the possibility of defining and validating quality standards, further multicenter studies should be performed.

Ambulatory Surgical Procedures↗
PubMedDate not supplied

Effects of specific immunotherapy on the development of new sensitisations in monosensitised patients.

BACKGROUND: Specific immunotherapy (SIT) is the only treatment that interferes with the basic pathophysiological mechanisms of allergic disease and is widely used in the management of clinically significant respiratory IgE-mediated diseases. Nevertheless, until recently, information on the influence of SIT on the development of new allergic sensitisations has been scant. METHODS: One hundred consecutive patients (45 males and 55 females, aged 6 to 69 years) with respiratory allergic diseases and attending the allergy unit of a general hospital were selected. All had been diagnosed by clinical history and skin prick tests of allergic rhinitis and/or asthma, were monosensitised (71 to Dermatophagoides spp, 22 to Parietaria judaica pollen and 7 to grass pollen) and had been followed up as outpatients between 1990-98. Sixty-six patients had been treated with conventional SIT for at least 3 years, while thirty-four followed only environmental measures and drug treatment. Family atopy status (first-degree relatives), smoking, family pets (cat and/or dog), rhinitis and/or asthma symptom score and inhalant skin prick tests to the same aeroallergens were compared between baseline and after 3 to 5 years of treatment. RESULTS: No statistically-significant differences in the development of new sensitisations were observed between the two groups (36.4 % of SIT-treated patients versus 38.2 % in control group, RR = 0.97, CI 95 %: 0.72-1.3). Smoking, family atopy history and pets did not appear to be risk factors for the development of neosensitisations (p < 0.05). Nevertheless, SIT-treated patients presented a better clinical score than the control group, with improvements of 89.4 % and 61.8 %, respectively (p = 0.007). CONCLUSIONS: Three-year SIT did not protect against development of new sensitisations in monosensitised allergic rhinitis or asthma. Smoking, family atopy history and pets were not associated with development of new sensitisations. Clinical score improved significantly in the SIT-treated group compared with drug-treated patients.

Adolescent↗