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Biomedical subjects

M Suarez-Almazor

Publications and source records attributed to M Suarez-Almazor.

30 records · Page 2Linked to original sources
PubMed1995

Comparison of two different concentrations of hyaluronidase in patients receiving one-hour infusions of hypodermoclysis.

The purpose of this randomized, double-blind study was to compare 300 units of hyaluronidase per one-half liter to 150 units per one-half liter in patients receiving brief infusions for subcutaneous hydration. Twenty-five evaluable patients were randomized to receive a local injection of 300 units of hyaluronidase or 150 units of hyaluronidase immediately before two 1-hr infusions of two-thirds dextrose 5% and one-third normal saline solution (500 cc volume). The following day a crossover took place, and patients received the alternate treatment before each of the two 1-hr infusions. The intensity and swelling as reported by the patient (visual analogue scale 0-100), and the intensity of edema and rash as assessed by the investigator (score 0-4) were not significantly different between groups. The patients' and investigators' final choice was also not significantly different. Patients could not distinguish between bolus and their previous experience with overnight clysis. Our results suggest that brief infusions are well tolerated for subcutaneous hydration of patients with advanced cancer. A concentration of 150 units of hyaluronidase per one-half liter is well tolerated in this population.

Aged↗
PubMed1995

The frequency of alcoholism among patients with pain due to terminal cancer.

The purpose of this retrospective study was to determine the prevalence of alcoholism among terminally ill cancer patients when assessed by multidisciplinary interviews and by the CAGE Questionnaire. We reviewed the charts of 100 consecutive patients assessed by a multidisciplinary team for the presence of alcoholism during 1989, and 100 consecutive patients assessed by the CAGE Questionnaire during 1992. Alcoholism was diagnosed in 28/100 patients during 1989 (28%) and 18/66 patients during 1992 (27%). Thirty-four patients were unable to complete the CAGE Questionnaire in 1992 because of sedation or cognitive impairment; six of these patients (17%) were found to be alcoholics after multidisciplinary assessment. Only 9/28 (32%) and 8/24 (33%) patients diagnosed as alcoholics during 1989 and 1992, respectively, had been previously diagnosed as alcoholics according to the medical charts. The mean equivalent daily dose of morphine during admission and on Day 2 during 1992 were 153 +/- 193 mg and 183 +/- 198 for alcoholic patients, versus 58 +/- 80 and 70 +/- 79 mg for nonalcoholics (P = 0.06 and 0.03, respectively). The maximal dose of opioid and the pain intensity during admission, however, were not significantly different between alcoholics and nonalcoholics. Our results suggest that alcoholism is highly prevalent and underdiagnosed among symptomatic terminally ill cancer patients. The CAGE Questionnaire should be used for screening for alcoholism in this population. When multidimensional assessment and management of pain is applied, the outcome of alcoholic patients appears to be similar to that of nonalcoholics.

Aged↗
PubMed1995

Opioid rotation for toxicity reduction in terminal cancer patients.

Accumulation of active (toxic) metabolites of opioids might explain cases of opioid toxicity when high doses are used for long periods of time. Other mechanisms of late toxicity of opioids may be found at the receptor level. Whatever the cause, a change of opioids using equianalgesic doses can be expected to improve symptoms of toxicity in some patients, while maintaining pain control. We reviewed the experience with this technique in patients admitted to the Palliative Care Unit of the Edmonton General Hospital. Of 191 patients, 80 underwent opioid rotation (OR) for cognitive failure, hallucinations, myoclonus, nausea and vomiting, local toxicity, and persistent pain. These leading symptoms improved in 58/80 patients (73%, P < 0.01). Pain control, as measured on a 10-cm visual analogue scale (VAS), improved from 4.4 +/- 2.3 to 3.6 +/- 2.0 (P < 0.004) at a dose significantly lower than that predicted to be equianalgesic (577 +/- 1535 mg before OR versus 336 +/- 593 mg after OR, P < 0.04). We conclude that symptoms of opioid toxicity can be relieved by OR, and that a choice of two or three different opioids is necessary to obtain satisfactory long-term pain control.

Aged↗
PubMed1995

Polymorphism in the LMP2 gene influences susceptibility to extraspinal disease in HLA-B27 positive individuals with ankylosing spondylitis.

OBJECTIVE: To investigate the potential influence of the HLA-linked LMP2 gene on disease susceptibility in HLA-B27 individuals with ankylosing spondylitis (AS). METHODS: A polymorphic CfoI restriction enzyme site in the coding region of the LMP2 gene was evaluated in genomic DNA samples from 193 white and 49 Chinese B27 individuals with well documented AS, 97 of whom had had acute anterior uveitis (AAU) and 97 peripheral arthritis; 42 samples from normal, white, B27 positive blood donors in whom AS was excluded were also evaluated. RESULTS: Analysis of B27 white AS individuals with AAU, peripheral arthritis, or both, revealed significant differences in genotypic distribution of this bi-allelic locus compared with B27 AS patients without extraspinal manifestations (p < 0.005) or B27 controls (p < 0.01). Furthermore, homozygosity for one LMP2 gene allele was significantly more prevalent in AS patients with AAU (71.3%) (p < 0.01) or peripheral arthritis (68.3%) (p < 0.02) than in B27 controls (45.2%). A similar genotypic distribution was noted in B27 Chinese AS individuals with extraspinal manifestations compared with those with axial disease alone. CONCLUSIONS: These findings support the involvement of the HLA linked LMP2 gene in the expression of disease in B27 individuals and represent a novel finding in rheumatic disease.

Adult↗
PubMed1995

An assessment of the needs of family physicians for a rheumatology Continuing Medical Educational program: results of a pilot project.

OBJECTIVE: To assess the needs and determine the effect of a Continuing Medical Education (CME) program designed for primary care physicians on the management of osteoarthritis (OA). METHODS: The needs of potential CME consumers were determined using a standardized case recall questionnaire on the management of OA. A CME program was designed to specifically address identified needs, and the effect of the program was determined by repeat questionnaire by participants at 3 mo followup. RESULTS: Primary care physicians had a high rate of use of nonsteroidal antiinflammatory drugs (NSAID) and a proportionately low rate of use of analgesics. Physiotherapeutic modalities and local steroid injections were underused. There was a relatively low appreciation of potential side effects of therapeutic choices and possible risk factors for toxicity. After participating in the CME program, attendees demonstrated change in their therapeutic practices with an increased awareness of relative risks/benefits of NSAID vs analgesics. CONCLUSION: A case recall questionnaire format is a simple and inexpensive means of determining the need for developing a specific program for, and determining the effect of a CME program applicable to rheumatology CME activities for primary care physicians.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1994

The assessment of constipation in terminal cancer patients admitted to a palliative care unit: a retrospective review.

Constipation is a frequent and distressing complication in patients with advanced cancer. However, very few studies have reviewed the assessment and management of these patients. The purpose of this study was to review the documentation and assessment and diagnosis of constipation in patients admitted to a Palliative Care Unit, and the correlation between those findings and radiological evidence of stool in the colon. The records of 122 consecutive patients admitted to the Palliative Care Unit, Edmonton General Hospital were reviewed in order to assess the physician's and the nurse's record of symptoms, physical findings, and diagnosis and treatment of constipation. All patients also underwent a flat abdominal radiograph that scored for the presence of stool in the colon (0 = no stool; and 12 = stool occupying all the lumen of the four quadrants of the colon). The radiograph was scored blindly by two different physicians. Of 103 evaluable patients, a rectal exam was reported only in 42. Correlation between the assessment by the two physicians' radiograph score was high (0.78, P nd nurses' diagnosis of constipation, the presence of laxative treatment, the number of days since the last bowel movement, and the source of the admission (hospital vs home) were not associated with higher radiological scores for constipation. Assessment is insufficient in this population at high risk for severe constipation. Radiological examination may be necessary for adequate diagnosis in some patients. More research is needed in this area.

Aged↗
PubMed1994

Performance of online biomedical databases in rheumatology.

OBJECTIVE: To compare the performance of MEDLINE, EMBASE, and BIOSIS in selected rheumatology topics. METHODS: Online literature searches were conducted with regard to the epidemiology of rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and ankylosing spondylitis (AS), as well as for 3 specific questions representing clinical, clinical/laboratory, and therapeutic topics in rheumatology. Total number of citations retrieved, type and language of publication, percentage of contribution from rheumatology journals, and degree of overlap among the databases were recorded. Publications retrieved for the 3 specific questions were also graded for relevance. RESULTS: For 1991, each online biomedical database (OBD) retrieved more than 1,100 citations for RA, over 600 for SLE, and over 110 for AS. For the epidemiology subtopic, fewer than 25% of the citations were retrieved by more than one of the databases. About 3/4 of the citations obtained for the specific search questions were retrieved by a single database. No major differences were observed among databases in relation to number of relevance of citations retrieved. Over 60% of the papers assessed had low relevance in relation to the topic of the search. Efficiency was estimated as the percentage of all relevant citations retrieved by each OBD. Results varied according to the topic, but in most cases each database retrieved at least 50% of the relevant citations. About 45% of the citations retrieved for the 3 search questions were published in nonrheumatology journals. CONCLUSION: No database was superior in all respects. The majority of the citations were retrieved by a single database. A high percentage of the articles retrieved were not relevant, implying low specificity. If a comprehensive online search in rheumatology is required, 2 or more databases should be utilized.

Arthritis, Rheumatoid↗
PubMed1994

Polymorphism in an HLA linked proteasome gene influences phenotypic expression of disease in HLA-B27 positive individuals.

OBJECTIVE: To investigate the potential influence of the HLA-linked LMP (low molecular weight polypeptide) genes on disease susceptibility in HLA-B27 individuals with ankylosing spondylitis (AS). METHODS: A polymorphic CfoI restriction enzyme site in the coding region of one proteasome gene was evaluated in 125 genomic DNA samples from B27 individuals with well documented AS, 55 of whom had had acute iritis, and 42 samples from normal, ethnically matched B27 blood donors where AS was excluded. RESULTS: Analysis of individuals with B27 AS with iritis revealed significant differences in allelic distribution of this biallelic locus compared to patients with B27 AS without iritis. Furthermore, homozygosity for the disease associated allele was significantly more prevalent in patients with AS with iritis (72.7%) than in patients without iritis (38.6%) (p(uncorrected) = 0.0003) or B27 controls (45.2%) (p(uncorrected) = 0.01). CONCLUSION: Our findings support the involvement of additional HLA linked genes in the phenotypic expression of disease in B27 individuals and suggest a role for the non-B27 HLA haplotype in susceptibility to iritis.

Adult↗
PubMedDate not supplied

Low tear production in patients with diabetes mellitus is not due to Sjögren's syndrome.

OBJECTIVES: The purpose of this study was to determine whether low tear production in patients with diabetes mellitus (DM) was related to autonomic nervous system abnormalities, to Sjögren's syndrome, as suggested by a previous study, or to other factors. DESIGN: Cross-sectional study assessment of patients with DM. PATIENTS AND METHODS: One hundred patients with diabetes mellitus (DM) attending the University of Alberta Outpatient Education Program for DM were consecutively included. All patients were assessed for keratoconjunctivitis sicca with a questionnaire. Tear production was assessed with Schirmer tests and patients with abnormal findings were further examined by an ophthalmologist. The effect of possible confounding factors was also evaluated: all patients underwent standard tests for the diagnosis of autonomic neuropathy and laboratory tests including lipid profiles, fasting blood glucose and levels of HbA1C. Antinuclear antibodies (ANA) were determined using HEp2 cells and various substrates for specific autoantibodies. RESULTS: Twenty-one of the patients had symptoms compatible with keratoconjunctivitis, and 25 had an abnormal Schirmer test. None of these 25 had abnormal corneal staining. Sixty one patients had evidence of autonomic neuropathy. Antinuclear antibodies were detected in 6 patients and anti-Ro in one other. Multiple regression analyses using the Schirmer test as a dependent variable, and controlling for all the independent variables, showed an association with autonomic neuropathy. No significant associations were observed with the other variables, including the presence of autoantibodies. CONCLUSION: Our results suggest that the low tear production seen in some DM patients is related to disfunction of the autonomic nervous system and not commonly to Sjögren's syndrome.

Adolescent↗
PubMedDate not supplied

Research in rheumatology: a six-month review of selected medical journals.

Research in rheumatology has dramatically increased in the past decades, and researchers can choose among over 20,000 journals to publish their findings. The purpose of this study was to examine the current extent and impact of rheumatological research on the medical literature. The tables of contents of 1,158 biomedical journals were analyzed during a 6-month period and those with a rheumatology-related title were selected. In total, 2,549 articles from 406 journals were related to rheumatology. The 10 rheumatology journals selected for the analysis contained 769 articles (30% of the total); thus, over two-thirds of the information on rheumatology topics was provided by non-rheumatology journals. Over 65 different journals included information about rheumatoid and systemic lupus erythematosus. It is concluded that research in rheumatology is extensive and widespread. Since articles in rheumatology are scattered over a variety of journals, it is suggested that the periodic publication of a rheumatology reference index may assist rheumatologists in updating information from various sources.

Animals↗
PubMedDate not supplied

Cardiac manifestations in dermato-polymyositis.

OBJECTIVE: To describe the functional and anatomic heart abnormalities of patients with dermato-polymyositis. METHODS: Thirty-two consecutive patients with dermato-polymyositis (DM/PM) were studied. Patient assessments included a questionnaire for cardiac symptoms, physical examination, muscular enzymes, standard electrocardiogram (EKG), chest radiographs, spirometry, Holter monitoring and color Doppler flow (CDF) studies. Features evaluated with CDF included left ventricular diastolic dysfunction (LVDD), hyperdynamic heart, mitral valve prolapse, and endomyocardial fibrosis. RESULTS: Twenty-five patients (78%) were female. The mean age was 43 years and the mean disease duration 6 years. Twenty-six (81%) patients had dermatomyositis. Only 2 (6%) had cardiac symptoms. Spirometry was performed in 20 patients, Holter monitoring in 23 and CDF in 26 patients. Electrical disturbances detected by either EKG or Holter were present in more than half of the patients studied. LVDD was identified in 11 patients (42%) and hyperdynamic heart in 4 (15%). None of the 26 patients studied by CDF had mitral valve prolapse. No significant differences in the frequency of cardiac abnormalities, including LVDD, were observed in relation to the diagnosis of DM or PM, the presence of Raynaud's phenomenon or calcinosis, or the disease activity status at the moment of the study. CONCLUSIONS: Subclinical heart abnormalities are frequent in patients with DM/PM. LVDD appears to be common. Our findings suggest that cardial assessment of patients should be performed in order to detect abnormalities requiring specific therapy.

Adolescent↗