Biomedical subjects

Martín Ruiz

Publications and source records attributed to Martín Ruiz.

15 recordsLinked to original sources

PubMed2006

Pacemaker-related endocarditis: clinical features and treatment.

BACKGROUND AND AIM OF THE STUDY: Removal of the entire infected system is the traditionally indicated management of pacemaker lead endocarditis (PLE), based on expert recommendations. Herein is described the present authors' experience with this condition. METHODS: Between 1987 and 2004, all consecutive patients with PLE treated at a tertiary referral university hospital and a community hospital were prospectively selected. Clinical features, management and outcome were analyzed. RESULTS: Thirteen cases of PLE were diagnosed. Surgery was performed in 10 cases, and medical treatment alone in three (due to advanced age in two cases and because of terminal colon cancer in one case). Four subjects died before discharge: three deaths occurred after surgery (one patient died due to refractory ventricular arrhythmia and two from persistent sepsis), and one unoperated patient died from sepsis and severe renal failure. No deaths or late surgeries were observed after a mean follow up period of 37 +/- 14 months. Both patients who survived hospitalization and underwent only medical treatment were free from late complications after 30 and 60 months follow up, respectively. CONCLUSION: Some patients with PLE present a good evolution without surgery, suggesting that surgical treatment is not mandatory in this situation. However, an indication for surgery may be similar to that for other cases of infective endocarditis.

Adult↗

PubMed2006

[Heart failure with preserved ejection fraction. Effect of etiology on prognosis].

INTRODUCTION AND OBJECTIVES: Heart failure with preserved systolic function accounts for almost 40% of heart failure cases. Prognosis is similar to that in patients with a low left ventricular ejection fraction (LVEF). However, it is not clear whether the etiology of heart failure with preserved systolic function has an effect on prognosis. METHODS: We assessed 95 consecutive patients admitted to our hospital with heart failure and a LVEF>45%. Twenty-five (26%) had an ischemic etiology and 70 (74%), a non-ischemic etiology. RESULT: The patients' mean age was 73 (6) years, 60% were female, and their mean LVEF was 61 (7)%. These characteristics were similar in the two etiological groups. After a mean follow-up period of 53 (8) months (4-69 months; median 46 months), mortality was higher in ischemic patients (17.88 vs 2.37/100 patient-years; P<.0001), as was the rate of cardiovascular admissions (24.58 vs 4.14/100 patient-years; P<.0001). The rates of mortality due to heart failure and sudden death were also higher in ischemic patients, at 7.82 vs 0.59/100 patient-years, and 7.82 vs 0.30/100 patient-years, respectively (P<.0001). The higher overall admission rate found in the ischemic group was due to higher rates of admission for heart failure (14.53 vs 0.89/100 patient-years; P<.0001) and acute coronary syndrome (8.94 vs 1.78/100 patient-years; P=.003). CONCLUSIONS: In terms of prognosis, heart failure with preserved systolic function is not a homogeneous disease entity. Morbidity and mortality rates are higher in patients with an ischemic etiology. Moreover, different mechanisms are involved.

Aged↗

PubMed2005

Clinical features and outcome of non-drug-addicted patients with infective endocarditis and perivalvular abscess.

BACKGROUND AND AIM OF THE STUDY: Perivalvular abscess is a serious complication in infective endocarditis (IE) that confers a poor prognosis. Few data are available concerning the long-term outcome of these patients. The study aim was to determine clinical features and long-term prognosis of non-drug addict patients with IE complicated by perivalvular abscess. METHODS: Among a consecutive series of 241 patients with IE, 30 (12.4%) were diagnosed with perivalvular abscess and treated at the authors' institution over a 15-year period. A comparative analysis of patients with perivalvular abscess and other patients in the series was performed. RESULTS: Perivalvular abscess was more frequently associated with aortic valve endocarditis (93% versus 35%, p <0.05), and Streptococcus sp. was the predominant microorganism. Severe complications during hospital admission were more common in patients with perivalvular abscess (100% versus 61%, p <0.01). In-hospital mortality was significantly higher in patients with perivalvular abscess (33% versus 15%, p <0.05). Event-free survival at five years among survivors of the in-hospital phase was 86% in patients with perivalvular abscess, and 83% in those without abscess (p = NS). CONCLUSION: Patients with IE and perivalvular abscess have a higher in-hospital mortality rate, as major complications are more common in these patients. However, among patients who survived the active phase of the disease, long-term survival was similar with or without perivalvular abscess.

Abscess↗

PubMed2004

[Short-term results with the ross procedure. Does the etiology of aortic valvulopathy affect the outcome?].

INTRODUCTION: The Ross procedure has become established as an appropriate method for aortic valve replacement in children and young adults. There is controversy regarding the results of this surgical technique depending on whether the aortic valve disorder is congenital or acquired. The objective of this study was to analyze the outcome of this technique in different etiologies. PATIENTS AND METHOD: We analyzed 61 patients who underwent the Ross procedure between November 1997 and November 2001. Age range was 6 to 54 years, and 44 patients (72%) were male. The mean duration of follow-up was 15.6 (10.6) months. The aortic valve lesion was stenosis in 17 patients, regurgitation in 22 and both in 22. The patients were divided into two groups: etiology was congenital in group I (40 patients) and acquired in group II (21 patients: 14 rheumatic, 2 degenerative, 2 endocarditis and 3 other). RESULTS: Pre-intervention data showed significant differences in age, functional class and percentage of patients with previous cardiac surgery. In the last follow-up examination, autograft gradient and homograft gradient were similar in both groups. Diastolic and systolic diameters and left ventricle ejection fraction were normal in both groups and did not differ between groups. Major events during follow-up were: 1 patient died, 1 patient had endocarditis, and 2 patients needed stent implantation in the homograft in group I; 2 patients in group II underwent reoperation because of severe autograft dysfunction. There were no statistically significant differences between groups. CONCLUSION: Short-term morbidity and mortality associated with the Ross procedure are low in patients with either congenital or acquired aortic valvulopathy.

Adolescent↗

PubMed2003

[Prevalence of patent foramen ovale in young patients with cerebral ischemic accident of unknown origin].

INTRODUCTION AND OBJECTIVE: Patent foramen ovale has been associated with stroke in young patients with cryptogenic stroke. The purpose of this study is to examine the prevalence of patent foramen ovale in this group of patients, as well as their anatomical and functional characteristics by contrast echocardiography, trying to determine ictus risk markers in young patients with acute ischemic stroke. PATIENTS AND METHOD: Prospective study of 90 patients under the age of 50 who were hospitalised consecutively due to a clinical presentation suggestive of stroke. No cause was found in 55 out of 90 (group I) and the rest, in which an stroke was finally disregarded, were used as the control group (group II). A transthoracic and transesophageal echocardiography examination with 2 types of contrast agents was performed in all patients to determine the presence of a patent foramen ovale and its anatomical and functional characteristics. RESULTS: Patent foramen ovale was observed more frequently in group I than in group II (43 versus 21%; p < 0.05). Among patients with a patent foramen ovale those with an ischemic stroke showed greater mobility of the oval membrane, more frequent large shunts of contrast in a single frame in the left heart, and more frequent shunts at rest. Transesophageal echocardiography without contrast showed a high sensitivity (90%) and specificity (93%) for detecting anatomically permeable foramen ovale whereas contrast transthoracic echocardiography showed a low sensitivity (13%). There were no differences between the two contrasts used. CONCLUSIONS: Near half of young patients with ischemic stroke of an unknown origin have a patent foramen ovale. A bigger mobility of the membrane of the oval cavity and a large degree of shunt contrast as well as shunt at rest detected by contrast transesophageal echocardiography, seem to identify patent foramen ovale patients with ischemic stroke. In these patients, transthoracic echocardiography has low sensibility for detecting permeability of the foramen ovale.

Adult↗

PubMed2002

[Psychotic disorder secondary to suprarenal insufficiency caused by exogenous corticoids. Review of literature and a case report].

OBJECTIVE: Since their introduction as therapeutic agents, corticosteroids have been associated with psychiatric symptoms ranging from mood disturbances to (florid) psychosis. By the time there have been reported psychotic reactions in patients receiving steroids or after sudden withdrawal of long time corticosteroid therapy. We communicate a clinical case in which the exogenous short-treatment with corticosteroids produced an hypothalamic-pituitary-adrenal axis inhibition leads to a psychotic disorder two weeks later. METHOD: Case presentation, clinical and research literature review, and theoretical discussion. RESULTS: There is consensus in the literature that corticosteroids may induce psychotic disorders, but the published evidence documenting so is scant, consisting only of case reports. We did not find any reported case provoked by depot steroids like the one we present. CONCLUSIONS: The literature concerned with the prevention and management of corticosteroid-induced psychiatric adverse effects is rudimentary, and contains large amounts of clinical anecdotes. Due to the lack of formal and validated studies, these reports currently provide the only available direction to clinicians in managing these problems.

Adrenal Insufficiency↗

PubMedDate not supplied

[High-dose fluoxetine-induced mania. Review and case report].

We report the case of a 53 year old woman who attempted suicide taking one high-dose of fluoxetine, developing a manic episode 19 days later. We also make a review about antidepressant-induced mania. In patients with mood disorder, the frequency of antidepressant-induced mania switch has been estimated to be 3.7 to 33%, varying across studies that included different diagnoses and different antidepressant treatments. Among the used data basis (Medline) there are papers reporting fluoxetine-induced mania. All of them include patients receiving adequate dose and time fluoxetine treatment. We found no reports of switch occurring after one high-dose of fluoxetine. As the impact on the clinical management of antidepressant-induced manic switches is quite high, several studies have focused on the possible clinical predictors of this phenomenon. By the time, is not possible to determine whether a manic episode is due to the natural course of bipolar disorder or to the medication. Thus, the phenomenon of antidepressant-induced mania should be defined and investigated with controlled prospective studies.

Bipolar Disorder↗

PubMedDate not supplied

[QEEG and brain mapping. Historial develoment, clinical practices and epistemological issues].

Although it has been more than two decades since brain mapping was introduced in medicine, its scientific value and clinical practice have not been proved. This paper makes an overview about the historical development of brain mapping, its usefulness in psychiatry and lays epistemological issues concerning the role of technology in medical settings. Both historical and technological development of qEEG gives us the opportunity to think about complexity between ethics, science, technology and medicine.

Brain↗

PubMedDate not supplied

[A comparative study of suicide notes in over 65 years old patients (preliminary data)].

OBJECTIVE: To determine, in older suicide attempt inpatients, differences between leaving a suicide note and not leaving it as regards age, sex, marital status, religion, living alone, level of education, present psychiatric treatment, severity of suicidal attempt, previous suicidal arousal, afterwards suicidal arousal, suicidal ideation, hopelessness, depression, dementia, narcissistic personality disorder, physical pain, previous suicide attempt, familiar history of suicide or suicide attempt. MATERIAL AND METHODS: This is a comparative, prospective, observational, transversal, single blind study. RESULTS: We studied 31 patients. Statistical significant associations were found between leaving a suicide note and hopelessness (p=0.03;OR=8.57;IC=1.19-95.33) and severe suicide attempt (p=0.022;OR=8.40;IC=1.28-63.88). DISCUSSION: Although associations between writing suicide notes and hopelessness have not been reported, our results are not surprising because, on one side, the severity of the suicide attempt is more related to hopelessness than to any other depressive parameter and, on the other side, leaving a suicide note is associated to severe suicide attempts. Finally, to feel hopeless and to leave a suicide note are associated to severe suicide attempts.

Aged↗

PubMedDate not supplied

[Suicidal behavior in adolescents. Risk factors (bibliography review and descriptive-analytical study)].

UNLABELLED: In the United States suicide is the third cause of death among adolescents. Suicidal behavior has increased a hundred percent over the last three decades; it is one of the most frequent psychiatric emergencies and the first cause of admission among inpatients between 15 and 24 years. OBJECTIVE: This paper is divided in two parts. The first one is made up of a review about risk factors for suicidal behavior in adolescents. The objective of the second part study is to estimate the frequency of risk factors for suicidal behavior in a sample of inpatients and to correlate them with high lethality suicidal attempts. METHOD: This is a retrospective, observational, descriptive, analytic transversal study based on information from 23 medical records. Variables were processed by bivariated analysis; relative risk was obtained considering high lethality suicidal attempt as dependent variable. RESULTS: Statistically significant relationships were found between high lethality suicidal attempt and no Axe II diagnosis and with the appearance of hopelessness. DISCUSSION: Suicidal attempts in adolescents with an Axe II diagnosis could be more related to self-harming than to a wish to die. Hopelessness can be considered an independent variable that determines the lethality of the suicidal attempt.

Adolescent↗

PubMedDate not supplied

[Post-traumatic stress disorder and substance use disorder: epidemiology, nature and neurobiology].

Post-traumatic stress disorder (PTSD) is frequently associated with other psychiatric diagnoses, being substance use disorder (SUD) one of the most prevailing. Comorbid disorders in general and SUD in particular frequently complicate the course and outcome of PTSD, and vice versa. As with other dual disorders, comorbidity of PTSD and SUD is complex, having been proposed different theoretical models to explain it that will be discussed in the present paper, the first of a series of two. In addition, the present paper reviews data from epidemiological studies, as well as the clinical characteristics, the relevance of stressful life events as a vulnerability factor to PTSD as well as to SUD and the neurobiological basis of the association of both disorders with the aim of gaining a better understanding of this comorbidity, so that the treatment of this dual disorder will be discussed in the second part.

Female↗

PubMedDate not supplied

[Therapeutic community model in short psychiatric hospitalization. Descriptive study on the dynamic psychiatric inpatient unit of the Italian hospital of Buenos Aires].

OBJECTIVE: the aim of this paper is to communicate a project of short term psychiatric hospitalization, based on a therapeutic community model, considering qualitative and quantitative aspects in the present socio - cultural context. INTRODUCTION: this psychiatric hospitalization model that embraces psychodynamic and pharmacological interventions is focused in the intensity of interactions between members of the therapeutic community and integrated to the administrative structure of a general hospital; this will be the key to consider patient's return to the community and to move forward over the prejudices that inpatients suffer. MATERIAL AND METHODS: quantitative, prospective, observational and transversal study on a Dynamic Psychiatric Inpatient Unit. 605 patients were included. RESULTS: mean length of stay was 16.34 days; principal causes of admission were depression (19.4%), suicide ideas (17.7%), suicide attempt (17.6%), substance abuse or dependence (14.3%), psychosis (13.8%), behavioral and psychological symptoms of dementia (6%). There were 75 readmissions. 14.88% patients were physically restrained. Principal Axis I diagnosis were depression (32.1%), substance dependence (13.2%), bipolar disorder (10.2%), dementia (7.6%), schizophrenia (7.5%), and psychotic disorder (5.8). Axis II diagnosis were borderline personality disorder (27.3%), narcissistic personality disorder (8.9%), histrionic personality disorder (5.3%). DISCUSSION: this kind of approach shows a structural model that allows possible and persistent favorable changes for psychiatric inpatients.

Argentina↗

PubMedDate not supplied

[Sexuality and dementia: a case study].

In this paper we will discuss about sexuality in people with dementia, trying to show difficulties that arise and that affect the patient, his or her partner, the family and the geriatric institute if the patient lives there. Five clinical cases are described and deeply analyzed. Many times psychotropic medications are central in the treatment plan for people with dementia and some kind of sexual difficulty; but this is not enough. We think that it is necessary to combine pharmacologic approaches with others from human sciences that fit with our patients' difficulties.

Aged↗

PubMedDate not supplied

[Psychogeriatric unit within a General Hospital. Descriptive analysis of outpatient assessment, diagnosis and treatment].

OBJECTIVE: To assess the frequency of some epidemiological variables in 200 patients over 65 years old that came to admission as outpatients in the psychogeriatric area in the psychiatric unit at the Hospital Italiano in Buenos Aires, Argentina. METHOD: A specific questionnaire was completed by both patient (or relative) and the physician. RESULTS: 83% were female and 17% male. The most important diagnosis were depressive disorder (34%), adaptive upheavals (28%) and dementia (16%), within this group, major depressive disorder and Alzheimer dementia. Only a 31% patients went under a neuropsychological assessment psychotherapy was indicated to 18% of the patients, pharmacology for 39%, memory improvement group for 18% and combined treatment for 25%. CONCLUSION: This paper brings data regarding outpatients over 65 years old with psychogeriatric treatment. This may improve the health system in psychogeriatric area taking into account socio-cultural and economic factors.

Aged↗

PubMedDate not supplied

[Adolescents' suicide attempt with their parent's psychotropic medication: descriptive study].

OBJECTIVE: To determine the frequency in adolescents under 21 years old hospitalized in the Psychiatric Unit of Hospital Italiano of Buenos Aires because of suicide attempt with pills taken by their parents. POPULATION AND SAMPLE: This study was carried out in a population of patients under 21 years old hospitalized in the Psychiatric Unit of Hospital Italiano of Buenos Aires between September 2004 and February 2006. MATERIAL AND METHOD: This is a quantitative, prospective, observational and transversal study. The variables considered were age, gender, cause of admission, suicide method. When the attempt was done with pills we considered what kind of pills and whom they belong to; we also asked about familiar psychiatric history and familiar history of suicide attempt and suicide. RESULTS: We analyzed data from 85 patients. 67% (n=57) were female and 33% (n=28) male. Age range was between 13 and 21 years with a media of 18,05 +/- 2 years. The principal cause of admission was suicide attempt (40,5 +/- 3,68%) (n=45). The suicide attempt method most frequently used was the ingestion of pills (77,8 +/- 9,6%) (n=35). DISCUSSION: The majority of adolescents who took pills did it with medication belonging to their parents ( 82,8 +/- 16,32%) (n=29). Within this medication 93% (n=27) were psychotropics. The availability of suicide methods is related directly to suicide. Without this methods near many autoagressive impulses may be restrained. The importance of this availability of this methods is often underestimated instead of being modified by prevention.

Adolescent↗