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Biomedical subjects

M Valdés

Publications and source records attributed to M Valdés.

At least 19 recordsLinked to original sources
PubMed1992

[Cardiac anatomical and functional changes in a group of young type I diabetics with microangiopathy].

BACKGROUND: There are conflicting data concerning the alteration of cardiac function in diabetics without another type of accompanying pathology. Therefore this study was designed with the aim to analyze the anatomical and functional changes and relate them with the time and control of diabetes. METHODS: Fifty-four type I diabetics with a mean age of 33.5 years and 25 healthy controls paired by age and sex were studied. The patients were rigourously selected excluding any disease or treatment other than insulin and the presence of demonstrated microangiopathy was required. M-mode and bidimensional echocardiographic studies were carried out in 46 patients to calculate thickness, cavity dimension and systolic function rates. Doppler-echo studies analyzing 9 parameters of diastolic function were performed in all the 54 patients studied. RESULTS: The results obtained demonstrated significant differences in the thickness of the posterior wall and the septum in the diabetics in comparison with the normal subjects. No differences were observed in the parameters of systolic function with the diastolic parameters being significant. Considered globally 41% of the patients demonstrated structural alterations, 4% systolic and 70% diastolic. The only significant correlation was established between the diastolic alteration and the time of evolution of the diabetes. The autonomic alteration which some patients presented did not vary the results obtained. CONCLUSIONS: In this group of selected diabetic structural and cardiac diastolic alterations appeared being attributed only to the diabetes itself in relation to the length of time of the same and possibly to the microangiopathy.

Adolescent↗
PubMed1992

Cardiac rhythm in healthy elderly subjects.

To study the normal cardiac rhythm in elderly subjects we performed 24-h Holter monitoring on 94 subjects aged over 70 years. We had previously discarded those with cardiac disease by using history, physical examination, electrocardiography (ECG), chest X-radiography and Doppler echocardiography. The maximum, average and minimum heart rates were 113, 79 and 62, respectively, during the day, and 90, 64 and 53 during the night. Supraventricular and ventricular arrhythmias were frequent (91% and 89.4%, respectively). Some 50% of the subjects had complex ventricular arrhythmias. Two subjects presented with sinus pauses of more than 2 s, and 4 had Wenckebach second-degree atrioventricular (AV) block. During a follow-up averaging 20.8 months, there were no deaths or symptoms of an arrhythmic origin.

Aged↗
PubMed1992

QEEG in a public health system.

For the past decade the Cuban Neuroscience Center has organized on behalf of the Ministry of Public Health of the Republic, a nationwide Program for the introduction of quantitative EEG (qEEG). This Program has involved a) development of standardized equipment for "paperless" EEG, qEEG and brain topography; b) establishment of a network of 21 laboratories of clinical neurophysiology; c) creation of the specialty of clinical neurophysiology which trains physicians from all provinces in both traditional and quantitative electrophysiological methods; d) introduction of standardized protocols for the collection of clinical and electrophysiological information; e) organization of a national normative and neuropsychiatric database; f) establishment of normative regression equations. Among the special issues discussed are: 1) relationship between traditional and quantitative methods; 2) evaluation of the effectiveness of the technology introduced; 3) use of qEEG in the early detection of brain dysfunction.

Adolescent↗
PubMed1992

Denial mechanisms in myocardial infarction: their relations with psychological variables and short-term outcome.

From a selected sample of 97 males suffering from a first myocardial infarction, 67 patients were studied to ascertain the influence of denial mechanisms (DM) on their cardiological and psychological outcome. There were no differences among high deniers and low deniers with respect to the cardiological outcome, but high deniers showed less anxiety and depressive reactions both in the coronary unit and 1 month later, and also presented less psychopathology in general. In the last evaluation, one year after leaving the hospital (N = 52), there was no difference among deniers and non deniers in demand for psychiatric attention.

Adaptation, Psychological↗
PubMed1992

[Infections in the diabetic. Comparative study of infections in the foot and other locations].

Given the high morbi-mortality of foot infections among the diabetics and the poor knowledge of their predictive, clinical and evolutive factors, we have retrospectively studied a group of patients with these characteristics, comparing them with infections among diabetics affecting other locations. We studied 66 infections among diabetics: 34 patients with diabetic's foot and 32 with infections at other locations: 20 pyelonephritis and 12 pneumonias. Medical records were obtained in all cases and all patients underwent a complete physical exploration in order to assess their risk factors. We observed as a significant predictive factor of diabetic's foot, diabetes type I, with an evolution longer than 10 years, neuropathy, vasculopathy or retinopathy. From the clinical point of view and compared with the other infections, these patients showed longer hospitalization, greater initial clinical severity, glucemias higher than 200 mgr/l., anemia and high GSR. Ethiologically, the infection of diabetic's foot was polymicrobian in 42.3% of all cases, being S. aureus the microorganism more frequently isolated. On the contrary, in infections at other locations, monomicrobian flora was more frequent, being E. coli the most frequent in pyelonephritis and S. pneumoniae in pneumonias. The evolution was satisfactory in all cases, with a close medical and surgical combined treatment and the appropriate use of antibiotic combinations, mainly clindamicine + tobramicine in the diabetic's foot and cefuroxime in the other locations.

Bacterial Infections↗
PubMed1992

[An analysis of the circadian rhythm of the heart rate and arrhythmias in healthy elderly subjects].

The incidence of asymptomatic arrhythmia detected by Holter monitor in the normal aged population is high. Nevertheless, there are few studies in the literature about the existence and characteristics of their circadian rhythm (CR). The aim of this study, is to determine the presence of CR of the heart rate (HR), supraventricular and ventricular extrasystoles (SVE, VE), atrial tachycardias (AT) and ventricular complex tachycardias (VCT) in the normal aged population. We studied 120 subjects, older than 70 years of age, belonging to a pensioner club, without apparent cardiovascular disease by history, physical, ECG, Chest X-Ray and echocardiography. All the patients had a 24 hours Holter monitor. 42 patients whose recording showed more than 50 SVE and/or more than 50 VE were included in the study. To study the CR the cosinor method was used. In the simple analysis, the HR had significant CR in 40 subjects (95.2%), the SVE in 18 out of 29 (62.1%) and the VE in 16 out of 26 (61.5%). The global analysis showed significant CR for the HR, with an acrophase at 15:47 hours (confidence limits at 95% between 14:45 and 15:42 hours) and for the VE, (acrophase: 15:35 hours, confidence limits between 11:53 and 19:05 hours). There was not significant CR for the SVE because the wide dispersion of the acrophases between the subjects. The AT had significant CR but no the VCT. We conclude that the majority of the aged normal subjects with frequent ectopy had significant CR for the HR and extrasystoles. The VE follow a CR similar to the frequency, suggesting a common modulation of the autonomic nervous system. The SVE variation follow a different CR.

Aged↗
PubMed1991

[Cerebral abscess in a general hospital. Analysis of 66 consecutive cases].

BACKGROUND: Analysis of the epidemiologic characteristics of cerebral abscesses and comparison with 2 therapeutic schedules. METHODS: The clinical history of 66 patients with cerebral abscesses admitted over 14 years in the Neurosurgical Ward of the Virgen de la Arrixaca Hospital in Murcia were reviewed. Two therapeutic groups were designed of 33 and 31 patients respectively treated with classical or modern schedules and clinical efficacy was evaluated. RESULTS: Infections in the ORL area, craneoencephalic trauma, and brain surgery were the predisposing factors in 63% of the cases. The most frequent symptoms were migraine, fever, and alteration of consciousness in 75, 68 and 68% respectively. The most frequent locations were the temporal (36%), parietal (26%) and frontal lobes (23%). Microbiological studies were positive in 75% of the patients with the most frequent microorganisms being group A Streptococcus, Proteus mirabilis, Staphylococcus aureus and anaerobes. Mortality was 14%. Twenty-two percent of the patients had neurological sequelae. The rate of mortality was significantly associated to age greater than 40 years, fatal underlying disease, coma, initial clinical criteria and inadequate antibiotic treatment. The combination of cephotaxime-metronidazole was significantly associated to greater cure in comparison with the classical antibiotic combination although no significant differences were found in either the rate of mortality or relapse. CONCLUSIONS: The combination of cephotaxime-metronidazole may constitute an interesting advance in the treatment of these processes. The epidemiological data obtained confirm those of larger series.

Abscess↗
PubMed1991

[Enterococcus faecalis bacteremia].

BACKGROUND: This study was prompted by the increasing role of E. faecalis in hospital acquired infections, their morbidity and mortality and the development of resistances. The aim of the study was to define the epidemiological features, the predictive factors of bacteremia and the mortality prognosis in a group of patients with E. faecalis bacteremia. METHODS: The clinical and epidemiological features on admission, after 3 days and one week of therapy and one month after therapy were evaluated in 57 cases of true E. faecalis bacteremia. The effectiveness of therapy was assessed by the rate of clinical and microbiological cures, deaths and survivals. RESULTS: The incidence of E. faecalis bacteremia was 5.9%. 78% of them were hospital acquired, with unknown source in 31%. Generally, they developed in surgical services and usually the patients had received antibiotic treatment or instrumentation. 63% of bacteremias were monomicrobial. Male sex, hospitalization (particularly in surgical or intensive care services), underlying disease of rapidly fatal prognosis, the previous use of third generation cephalosporins and/or ciprofloxacin, and previous instrumentation or surgery were found to be predictive factors of bacteremia. On the other hand, underlying disease with rapidly fatal prognosis, with initial poor or critical clinical condition, the previous use of wide spectrum antibiotics, polymicrobial bacteremia, and the presence of leukocytosis or complications were significantly associated with a higher mortality. The resistance rates ranged between 42% to kanamycin and 1% to amikacin. CONCLUSIONS: In view of the results, a better knowledge of the predictive and prognostic factors of E. faecalis bacteremia is required for prevention and treatment.

Enterococcus faecalis↗
PubMed1991

Comparison of the effectiveness of various antibiotics in the treatment of methicillin-susceptible Staphylococcus aureus experimental infective endocarditis.

The effectiveness of various antibiotics was tested in the eradication of a strain of methicillin-susceptible Staphylococcus aureus (MSSA) of cardiac vegetations, in an experimental model of endocarditis in rabbits. Twelve animals comprised the control group and 48 the treated ones. After inducing the experimental endocarditis, the animals were treated for three days; then mortality, blood cultures at 48 and 72 hours and the title of the colony forming units per gram of vegetation (CFU/g) were evaluated. Imipenem and the cloxacillin-gentamicin association were found to be as effective as cloxacillin in eradicating the microorganisms of the vegetation. Clindamycin in high doses was shown to be a valid alternative. Vancomycin, teicoplanin, rifampin and ciprofloxacin were less effective than cloxacillin. The experimental model seems to be an effective method for evaluating antimicrobial treatments in staphylococcal endocarditis.

Animals↗
PubMed1991

Comparison of the efficacy of three different treatments with imipenem versus the classical clindamycin plus tobramycin in experimental peritonitis.

This study compares the efficacy of three different treatment modalities of imipenem/cilastatin and the conventional clindamycin plus tobramycin in an experimental model of intra-abdominal sepsis. 145 Wistar rats were used. 40 served as control and 105 as study groups. A capsule with 0.5 ml of inoculum was surgically implanted in the peritoneal cavity. The inoculum was prepared from human feces of healthy volunteers, with a composition of E. coli 10(6), E. faecalis 10(6), B. fragilis, Clostridium sp 10(5) to 10(6) and anaerobic streptococci 10(5) to 10(6). Eighty animals were treated with imipenem/cilastatin and divided in 3 subgroups: "short pretreatment"--29 animals treated 1 hour prior to surgery and 3 days after; "short"--26 animals starting treatment 2 hours post-surgery and continuing it for 3 days; and "long"--25 animals treated for 10 days, starting 2 hours post-surgery. 25 animals received clindamycin plus tobramycin for 10 days. Mortality and the presence of visceral and peritoneal abscesses were the endpoints of the study. The control group had 100% mortality. There were no statistically significant differences among the treated groups although lower mortality was obtained with "short pretreatment" and "long" treatment with imipenem. The presence of abscesses were statistically significant between the imipenem and the combination group. In the imipenem groups, the "short pretreatment" and the long treatment had fewer abscesses than the short one. We conclude that imipenem may be a good alternative monotherapy to conventional therapy with clindamycin plus tobramycin. The "short pretreatment" seemed as good as the long one and better than the short treatment.

Abscess↗
PubMed1991

[The cardiac anatomical and functional changes in a group of young type-1 diabetics without microangiopathy].

We study 71 type I diabetics and 25 controls, trying to analyze the anatomical and functional changes due to diabetes. The diabetics, with a mean age of 18.4 +/- 8.2 years, were strictly selected excluding any disease and treatment besides insulin. In 66, and echocardiographic M mode and 2D study was done to calculate wall thickness, cavity dimensions and systolic function indexes; in all, Eco-Doppler analyzing 9 diastolic function indexes. The results showed an increase in septal thickness in diabetics (p less than 0.01 in diastole and less than 0.001 in systole). There was no difference in systolic function or posterior wall thickness, having the diabetics a significant increase of the T 1/2 (p less than 0.001), a decrease of the deceleration of E and the ratio E/A (p less than 0.001). As a group, 12.5% of the diabetics had anatomical abnormalities, and 18.3% diastolic abnormalities at least in two indexes. The only significant correlation was established between the evolution time and the T 1/2 (p less than 0.01). We conclude that in this group of selected diabetics, the anatomical and functional abnormalities found were only imputable to the diabetic abnormality.

Adolescent↗
PubMed1991

[Teicoplanin versus cloxacillin, cloxacillin-gentamycin and vancomycin in the treatment of experimental endocarditis caused by methicillin-sensitive Staphylococcus aureus].

Thirty-three rabbits, (12 in the control group and 21 treated, 5 with teicoplanin, vancomycin and cloxacillin-gentamycin and 6 with cloxacillin alone) with methicillin-sensitive Staphylococcus aureus (MSSA) experimentally induced endocarditis were studied to evaluate the efficacy of teicoplanin and its comparison with cloxacillin, vancomycin and cloxacillin-gentamycin. The rabbits were treated during three days. Mortality, blood cultures at 48 and 72 hours and the number of colonies forming units per gram of vegetation were then evaluated. There was statistically significantly differences between the control group and the 4 treated groups in respect of mortality (p less than 0.001), and blood culture's negativity at 48 and 72 hours (p less than 0.001), but not among the various groups of treatments. The CFU number of the vegetations were also significantly different between control and treatment groups (p less than 0.001). Cloxacillin and the combination cloxacillin-gentamycin lowered the CFU number more than teicoplanin and vancomycin (p less than 0.005). These results, allowed us to conclude than teicoplanin may be used as an alternative of standard treatments in infective endocarditis due to MSSA.

Animals↗
PubMed1991

[The spontaneous regression of a rhabdomyoma of the right ventricle].

Rhabdomyoma is the most common intracardiac tumor in the newborn. The diagnosis is made by the clinical history and the physical examination, the electrocardiogram, chest X-ray, and the echocardiographic data. It has a poor prognosis, 80% dying in the first year of life because congestive heart failure or sudden death. Rarely, spontaneous regression has been described. We present the case of a newborn diagnosed of tuberous sclerosis, with an echocardiographic image of a rhabdomyoma in the right ventricle with a spontaneous total regression of the tumor 2 years later.

Echocardiography↗
PubMed1990

Examination-associated anxiety in students of medicine.

The authors studied 262 medical students who were in the second year at the University of Barcelona School of Medicine in 1988. The authors measured the students' anxiety as the students were taking each of two examinations on different subjects: one on medical psychology and one on physiology. The State-Trait Anxiety Inventory questionnaire, recently validated in Spanish, was used to measure the students' anxiety associated with the examinations. In addition, analog scales were used to obtain the students' assessment of each examination's difficulty and its importance to them. The findings showed different levels of anxiety in examinations of different subject matters, with a positive correlation between the importance attributed to the examination and the associated anxiety, and a negative correlation between the importance of the examination and the importance attributed to chance in the marking. Implications of these findings and directions for future research are discussed.

Adult↗
PubMed1990

Miller Fisher syndrome associated with Q fever.

A 51 year old woman with pneumonia developed Miller Fisher syndrome. Indirect immunofluorescence tests showed antibodies against Coxiella burnetti. Miller Fisher syndrome associated with Q fever has not been described previously.

Antibodies, Bacterial↗
PubMed1990

[The development of a linear function for stratifying the risk of hospital mortality in acute myocardial infarct].

In spite of conventional treatment in a Coronary Unit, there is a group of patients with acute myocardial infarction who present a high mortality index. A more aggressive attitude (coronariography, angioplasty, and/or emergency coronary bypass) could improve the prognosis in some of these patients but can only be performed in a limited number of centers. In the present work, we have reviewed data obtained from the Emergency Room on 167 patients diagnosed of myocardial infarction. The variables that were correlated to mortality were: age, heart rate, blood pressure, presence of rales, radiologic heart failure cardiomegaly, ventricular extrasystoles in ECG and delay in arrival to hospital. We obtain a lineal function (z = 24.6 X1 - 0.4 X2 + 0.2 X3 + 11) which combining ventricular extrasystoles, diastolic arterial pressure, and heart rate permits to differentiate three risk groups: low, medium and high, associated to hospital mortality rates of 5.7, 36.4 and 83.3%. We suggest the use of a function of this type to select those patients who should be sent to a hospital with facilities for emergency coronary surgery.

Discriminant Analysis↗