PubMed Health⌕ Search

Biomedical subjects

M Picó

Publications and source records attributed to M Picó.

At least 19 recordsLinked to original sources
PubMed2005

Determinants of health system delay among confirmed tuberculosis cases in Spain.

BACKGROUND: Health system delay (HSD) is an important issue in tuberculosis (TB) control. This report investigates HSD and associated factors in a cohort of Spanish culture-confirmed TB patients. METHODS: Data were collected from clinical records. Using logistic regression with two different cut-off points to define HSD (median and 75th percentile), adjusted odds ratios were used to estimate the association between HSD and different variables. RESULTS: A total of 5184 culture-confirmed TB cases were included. Median and 75th percentile HSD were 6 and 25 days respectively. HSD significantly greater than the median was associated with: age >44 years, past or present intravenous drug use, diagnosis at a primary-care centre, prior preventive therapy, positive histology, request for drug-sensitivity testing, presence of silicosis or neoplasia in addition to TB, presence of non-TB related symptoms, and gastrointestinal site. HSD greater than the 75th percentile was related to the same variables, with the exception of diagnosis at a primary-care centre, positive histology, silicosis, non-TB-related symptoms and gastrointestinal site, for which the association disappeared; in contrast, an association with female gender emerged. CONCLUSION: Despite free health care being universally available in Spain, there are some groups of TB patients whose treatment is unduly delayed.

Adolescent↗
PubMed2004

Determinants of patient delay among tuberculosis cases in Spain.

BACKGROUND: Patient delay was investigated in a cohort of TB patients identified from May 1996 until April 1997 in 13 Autonomous Regions in Spain. The study covered almost 67% of the total Spanish population. METHODS: Data were collected from clinical records. Using unconditional logistic regression with two different cut-off points to define 'patient delay' (the median and 75th percentile), the association between patient delay and different factors was estimated. RESULTS: A total of 7,037 cases were included. Median and 75th percentile delays were 22 and 57 days respectively. Factors associated with patient delay greater than the median (p<0.05) were: non-respiratory symptoms of TB and age over 14 years, although the effect of age was not linear. Furthermore, an interaction was observed between intravenous drug user (IDU) and HIV status, in that, whereas patient delay was greater in IDUs than in non-IDUs among cases whose HIV status was either negative or unknown, among HIV-positive patients no such IDU-related differences were in evidence. Factors associated with extreme patient delay (greater than the 75th percentile) were essentially the same, but the above-described interaction disappeared, with IDU status showing no direct effect. In addition, likelihood of extreme patient delay increased in the case of alcoholism and female gender and decreased in the case of chronic renal failure, corticoid treatment, prison inmates and residents of old age homes. CONCLUSION: Although there is a universally enjoyed right to health care in Spain, some groups of TB patients could nevertheless be experiencing problems in seeking medical attention.

Adolescent↗
PubMed2002

Tuberculosis in Spain: epidemiological pattern and clinical practice.

SETTING: Thirteen Autonomous Regions in Spain. OBJECTIVE: To study the incidence of all forms of tuberculosis (TB) and investigate clinical practice in TB. DESIGN: Cases of all forms of tuberculosis diagnosed in the study setting from May 1986 to April 1997 were identified though active search of different databases. Clinical and epidemiological information on cases was collected from clinical records or by interview with physicians. RESULTS: The overall incidence of all forms of tuberculosis was 38.5/100,000 and the incidence of smear-positive disease was 13.83/100,000. Most cases (97.1%) were Spanish nationals, with rates higher in men than in women (52.7/100,000 vs. 24.87/100,000) and in groups aged 25-34 and 75 years and over (61.35/100,000 and 59.35/100,000, respectively). Disseminated forms were frequent (6.6%), and the most common risk factor was human immunodeficiency virus (HIV) infection (17.7% of cases). Hospitalisation was common (71.6%). Microbiological confirmation of diagnosis was sought for 87.7% of the cases (91.8% of pulmonary vs. 75.5% of extra-pulmonary cases), and 65.2% were culture-positive (73.8% of pulmonary vs. 39.7% of extra-pulmonary cases). HIV-infected patients were treated in almost equal proportions with three or four drugs (49.7% and 48.2%, respectively), while HIV-negative cases or those whose HIV status was unknown were usually treated with three drugs. CONCLUSION: The epidemiological pattern of TB in Spain is different to other industrialised countries in the age distribution of cases and the proportions of foreigners and cases with HIV infection. Microbiological confirmation of diagnosis is more common in pulmonary than in extra-pulmonary disease, and treatment with four drugs more frequent in HIV-positive cases.

Adolescent↗
PubMed1999

[The prognostic value of eicosanoids in the acute respiratory distress syndrome].

BACKGROUND: There is a great number of agents involved in the acute respiratory distress syndrome (ARDS) physiopathology, and some of them may have a prognostic value. The objective of the present study has been to analyse the prognostic value of eicosanoids in this syndrome. MATERIAL AND METHOD: A prospective study with 21 consecutive ARDS patients admitted to the intensive care unit of a therapy hospital in Barcelona, Spain, was carried out. In the first 48 h of the ARDS diagnosis, at baseline, the plasma levels, (in peripheral arterial and pulmonary arterial samples) of thromboxane B2 (TXB2), prostaglandin F1-alpha) (PGF1-alpha) and leukotriene B4 (LTB4) were analysed by RIA. Simultaneously we measured different pulmonary and systemic hemodynamical variables, as well as the pulmonary gas exchange data. We also studied the venous levels of the same eicosanoids in 17 healthy adults, used as reference. RESULTS: Plasma levels of eicosanoids in the ARDS patients were higher than reference subjects (p < 0.05). No differences were observed between systemic arterial and pulmonary arterial values. From all the eicosanoids, only LTB4, (in both systemic arterial and pulmonary blood), was correlated with LIS (r = 0.49, p < 0.05; and r = 0.45, p < 0.05, respectively). Patients who did not survive presented a lower systemic-pulmonary arterial gradient of eicosanoids levels than survivors (-1.27 vs -0.10 ng/ml; p < 0.01). CONCLUSIONS: In our ARDS patients only LTB4 plasma levels correlated with the severity of respiratory failure. Patients who did not survive presented a lower LTB4 gradient than survivors.

Adult↗
PubMed1999

Fatty acid composition of platelet membrane lipids after administration of two different fat emulsions in critically ill patients.

OBJECTIVE: To determine the effects on platelet membrane fatty acid composition following administration of two different fat emulsions. DESIGN: Prospective, randomized, double-blind study. SETTING: Intensive care unit in a university-affiliated hospital. PATIENTS: 12 adult critically ill patients in need of total parenteral nutrition. INTERVENTIONS: Patients were treated with total parenteral nutrition (TPN) for 7 days, receiving for fat intake either a long-chain triglyceride (20% LCT) emulsion (group 1, n=6) or a medium-chain triglyceride-LCT (20% MCT/LCT) emulsion (group 2, n=6). MEASUREMENTS AND RESULTS: High-performance liquid chromatography of membrane fatty acids was carried out before and after 7 days of TPN. In the LCT group, an increase in C18:2n-6 and a decrease in caprylic acid and docosahexaenoic acid, which resulted in a decreased ratio of n-3/n-6 fatty acid content, was observed. In the MCT/LCT group, a reduced percentage of palmitoleic acid and arachidonic acid was shown. CONCLUSIONS: The observed changes in fatty acid composition are in agreement with the lipid composition of the fat emulsions used. Because the C18:2n-6/C18:3n-3 ratio in both emulsions is close (approximately 9.0), the observed changes in the fatty acid composition of platelets may not be relevant for platelet function.

APACHE↗
PubMed1998

Anticoagulative effect of nitric oxide inhalation in ARDS.

Some studies have suggested that nitric oxide (NO) may cause platelet dysfunction. We present an ARDS patient who need this treatment, with a transient alteration of platelet function and a significant prolongation of bleeding time.

Acute Disease↗
PubMed1998

Gas exchange and pulmonary haemodynamic responses to fat emulsions in acute respiratory distress syndrome.

OBJECTIVE: To investigate the gas exchange and pulmonary haemodynamic responses to two different intravenous fat emulsions in patients with acute respiratory distress syndrome (ARDS). DESIGN: Prospective, randomized, double-blind, placebo-controlled study. SETTING: Intensive care unit in a university-affiliated hospital. PATIENTS: 21 patients with ARDS [mean age, 57 +/- 3 (SEM) years; Acute Physiology and Chronic Health Evaluation II, 20 +/- 3; Murray's score, 2.85 +/- 0.12] consecutively admitted. INTERVENTIONS: Patients were assigned to three groups (n = 7 each): group A (LCT) received long-chain triglycerides (20% LCT), group B (MCT/LCT), medium-chain triglycerides/long-chain triglycerides (20% MCT/LCT: 50/50) and group C placebo (0.9% sodium chloride, NaCl). The infusion was always given at the rate of 2 mg/kg min over a total period of 12 h, with a volume infusion of 500 ml in each group. MEASUREMENTS: Data were collected before, immediately after and 12 h after infusion ceased. Pulmonary and systemic haemodynamic and gas exchange variables were measured at each time point. Serum triglyceride cholesterol, and non-esterified fatty acids levels were measured. RESULTS: During LCT infusion, cardiac output, oxygen consumption and oxygen delivery increased (all p < 0.05), whereas pulmonary haemodynamics, arterial oxygen tension, mixed venous partial pressure of oxygen and venous admixture ratio remained essentially unaltered. No changes were observed following MCT/LCT infusion. CONCLUSIONS: The administration of LCT emulsion given at a slow rate did not alter arterial oxygenation because of the beneficial effect of a high cardiac output, hence offsetting the detrimental effect of increased O2 consumption.

Adult↗
PubMed1997

[Fluctuating molecular remission in patients with chronic myeloid leukemia with long term complete cytogenetic response after alpha interferon treatment].

BACKGROUND: Alpha interferon can induce complete cytogenetic responses (CGR) in nearly 25% of chronic myeloid leukemia (CML) patients, but few of them obtain molecular responses (i.e. disappearance of the chimeric RNA bcr-abl). The incidence and evolution of this response are not well known. PATIENTS AND METHODS: The molecular response has been explored in six CML patients, four in first chronic phase and two in relapse after bone marrow transplantation, who have obtained durable and sustained CGR. Bone marrow samples have been analyzed by double step RT-PCR. Results have been correlated with clinical and karyotype findings. RESULTS: Twenty nine samples have been studied. Every patient in first chronic phase CML have obtained molecular response, but this response has not been persistent. One of the patients with relapsing CML after showed transient PCR negativity, whereas persistent PCR positivity was detected in the other one. CONCLUSIONS: Interferon alpha can induce complete molecular responses in CML patients, but in this study this responses have been fluctuant in all the patients.

Adult↗
PubMed1996

Study of chimerism in long-term survivors after bone marrow transplantation for severe acquired aplastic anemia.

Chimerism studies employing PCR and Southern techniques targeting VNTR loci were performed in 17 severe acquired aplastic anemia patients who were long-term survivors after BMT. They were studied a median of 4 years after BMT (1-12). All patients had normal blood counts. All patients conditioned with radiation-based schemes showed a full donor pattern of hemopoiesis. Conversely, out of five patients who received only cyclophosphamide as conditioning therapy, two of them had a late graft failure (2.4 and 3 years after BMT). One of these relapsing patients had a durable mixed chimerism, which was first detected 1 month after BMT. Our results seem to suggest that durable mixed chimerism can antecede graft failure in some patients conditioned only with cyclophosphamide, and that a more stringent monitoring can be clinically rewarding in this group of patients.

Adolescent↗
PubMed1995

Hypertriglyceridemia may be severe in CML patients treated with interferon-alpha.

We analyzed serum triglyceride (TG) levels in 22 chronic myeloid leukemia (CML) patients treated with interferon-alpha (IFN-alpha). Hypertriglyceridemia was present in one-half of patients at diagnosis, and IFN-alpha treatment was associated with a further increase in 90% of the total group of patients. This increase was maximal during the first months of therapy. Four patients (18%) reached levels higher than 1,000 mg/dl. This is the first report describing this secondary effect in CML patients treated with IFN-alpha.

Adolescent↗
PubMed1995

[Alfa-2a interferon induces molecular remission in post-BMT relapse of chronic myelogenous leukaemia. Report of a case with loss of bcr-abl RNA].

Alpha-interferon (alpha-IFN) has been used in relapsed CML post-BMT, cytogenetic responses being attained in a number of cases (33 to 42%). In first chronic phase-CML patients such cytogenetic response has been correlated with the disappearance of the bcr region rearrangement, as seen with Southern-blot, but when RT-PCR is used only a small number of patients maintain undetectable traces of the Ph1 clone. A case of CML in haematological and cytogenetic relapse after BMT is reported who showed criteria of "accelerated" phase and, after treatment with alpha-IFN achieved haematologic, cytogenetic and molecular remission (Southern-blot and PCR negative) and disappearance of the abnormal clone with recovery of the donor haemopoiesis. The duration of the alpha-IFN cytogenetic response is longer than that of BMT (5 vs 3.5 yr), which is noteworthy. Taking the low toxicity of alpha-IFN into account, as compared with that of the other choices (a second BMT, IL2), this treatment should be offered to all patients with cytogenetic relapse after BMT.

Antiviral Agents↗
PubMed1994

Effect of two lipid emulsions on platelet function.

OBJECTIVE: To examine the effect of two lipid emulsions administered with total parenteral nutrition (TPN) on platelet aggregation and activation and the production of eicosanoids in nonseptic critically ill patients. DESIGN: Prospective, randomized, unblinded, non-crossover study. SETTING: ICU of a general teaching hospital. PATIENTS: 23 adult, critically ill, nonseptic patients, who were in need of TPN for at least 7 days. INTERVENTIONS: The patients were randomly distributed into 2 groups each of which received TPN with a different essential fatty acid content. The 2 lipid emulsions, Intralipid 20% (long-chain triglycerides) and Lipofundin MCT/LCT 20% (10% each of long- and medium-chain triglycerides) provided 43% of the nonprotein caloric requirements calculated for each patient. Parameters demonstrating platelet function (plasma beta-thromboglobulin, platelet factor 4, platelet aggregation, 6-keto-PGF1 alpha) were assessed before starting TPN and after 4 and 7 days of initiation. RESULTS: Before beginning lipid perfusion, platelet activation evaluated by beta TG and PF4 levels was notable, 6-keto-PGF1 alpha production was elevated and no hyperaggregation of platelets was observed in patients. The studies of platelet function at 4 and 7 days of TPN did not show significant changes with respect to the basal data or between the 2 groups. CONCLUSIONS: Our results indicate that platelet function was not affected by either of the 2 lipid emulsions administered to patients during the study period.

Adult↗
PubMed1992

[Resistance to antivitamins K].

Resistance to oral anticoagulant is a rare phenomenon. We report the case of a 32-year-old woman who required anticoagulation due to a deep venous thrombosis. She gradually developed resistance to acenocumarol and warfarin. Although the HPLC (high performance liquid chromatography) method proved satisfactory acenocumarol levels in plasma, therapeutic anticoagulation was not achieved. The mechanisms of resistance are discussed.

Acenocoumarol↗
PubMed1991

Platelet activation, endothelial cell dysfunction in the absence of anticardiolipin antibodies in systemic sclerosis.

The presence of anticardiolipin antibodies (aCL), von Willebrand factor activity and platelet function was studied in 35 patients with systemic sclerosis (SSc) scleroderma and 22 healthy controls. aCL positivity was observed in no patient with SSc or controls, whereas beta-thromboglobulin and platelet factor 4 levels were significantly higher in patients with SSc (p less than 0.001 and p less than 0.002, respectively). Furthermore, plasma from patients with SSc had a greater degree of aggregation to adenosine diphosphate 1 microM (p less than 0.05) but not to collagen or arachidonic acid. The plasma of patients with scleroderma also had increased von Willebrand factor activity compared with controls (p less than 0.001). We conclude that aCL appears not to play a central role in the pathogenesis of vascular and hemostatic alterations in SSc.

Adult↗
PubMed1990

Cutaneous drug reactions.

Cutaneous drug reactions are among the most common causes of skin eruptions in hospitalized patients. In outpatient clinics, drug eruptions represent a diagnostic and therapeutic challenge to the physician as any drug can cause an adverse cutaneous reaction. These reactions may be mediated by immunologic or nonimmunologic mechanisms. Cutaneous drug reactions may manifest themselves in various clinical morphologic patterns. Factors such as sun-exposure, concomitant drugs or diseases and host immune status can influence the type and morphology of lesions. History taking is one of the most important aspects in the evaluation of these patients and must be oriented so as to provide the information that will lead to the final diagnosis.

Diagnosis, Differential↗
PubMed1987

Low-dose acetylsalicylic acid (ASA) plus dipyridamole versus dipyridamole alone in the prevention of stroke in patients with reversible ischemic attacks.

A total of 243 patients who had reversible ischemic attacks (RIA) were submitted to clinical trial to determine whether dipyridamole (400 mg/day) (D) or aspirin (100 mg/48 hours) + dipyridamole (300 mg/day) (ASA + D) would produce significant reduction in the subsequent occurrence of RIA and completed stroke. One hundred and fifteen were selected for Group ASA + D and 71 were treated with dipyridamole only. The treatment groups were similar in relation to age, sex, risk factors, duration and presumed vascular territory of RIA, incidence of alterations of arterial supra-aortic trunks, cerebral infarct (CT scan), and platelet function. Patients were followed for a mean time of 21 months. At the end of the study, 21.7% of the ASA + D group and 19.7% in the D group had suffered new episodes of RIA or completed stroke (p = 0.88). Frequency of stroke (reversible ischemic neurologic deficit or completed stroke) was 7.8% in the ASA + D patients and 9.8% in the D patients (p = 0.83). Subgroup analysis did not show significant differences either. It is concluded that ASA + D has no significantly greater beneficial effect than that observed with D alone in the secondary prevention of atherothrombotic cerebral ischemia. However, a statistical Type II error cannot be excluded by the reduced number of recurrences.

Adult↗
PubMed1983

Microhaemorheological properties of binifibrate. Part II: Preliminary open studies in patients with peripheral arteriopathies.

3-Pyridinecarboxylic acid 2-[2-(4-chlorophenoxy)-2-methyl-1-oxo-propoxy]-1,3-propanediyl ester (binifibrate, Biniwas) an anti-arteriosclerotic and hypolipidaemic agent which showed an effect on microhaemorheological properties during studies in experimental animals (rat and rabbit), was administered to six hyperlipidaemic patients who suffered from circulatory disturbances in the lower limbs. The treatment with binifibrate was applied at a dosage of 3 X 600 mg/day during one month. Both subjective symptoms such as paraesthesia, dysthaesia, coldness at rest and functional weakness of movements were improved, as well as objective symptoms measured by oscillometry. The microhaemorheological analyses demonstrated a positive variation in relative parameters. The correlation between microhaemorheological parameters and clinical symptoms is discussed.

Adult↗