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Biomedical subjects

O Miró

Publications and source records attributed to O Miró.

At least 19 recordsLinked to original sources
PubMed2006

[Medical emergencies in the adult immigrant].

The need for medical care of the immigrant population is growing in proportion to the increase in the number of immigrants resident in Spain. This article reviews the socio-demographic characteristics of the immigrant population that come for consultations in the emergency services and discusses those particularities, both medical (neurocysticercosis, tuberculosis, infection by the AIDS virus, hepatitis, malaria, parasitosis, Ulysses syndrome) and paramedical (knowledge of the health card, concept of medicine, language barrier), that differentiate them from the native population. Nonetheless, since we are dealing with a young population that is in principle healthy, their reasons for consultation do not greatly differ from the general population. It is worth drawing attention to the high level of satisfaction of this population with the care afforded them in the hospital emergency services.

Adult↗
PubMed2004

Quality and effectiveness of an emergency department during weekends.

OBJECTIVE: To evaluate whether the quality and effectiveness of an emergency department (ED) are modified during weekends. METHODS: Quality and effectiveness markers were determined during 539 consecutive days, comparing them according to the day of the week. Quality markers were the daily percentage of patients who died in the internal medical unit (deaths, D), leave ED without being seen (flights, F); returned to the ED (revisits, R), and the percentage of registered complaints (C). Effectiveness markers were: the "number of patients waiting to be seen" (WP), the "waiting time to be seen" (WT), and the "length of visit" (LV). RESULTS: Quality and effectiveness of ED do not worsen during weekend days and some markers significantly improved during such days: C experienced a 26% decrease (p = 0.001), WT decreased 65% (p<0.001), WP 59% (p<0.001), and LV 24% (p<0.01). Assessing the relation between daily number of visits to ED and the quality and effectiveness markers, a significant and direct association was found of the number of visits with D, F, R, and WP. CONCLUSION: Some of the quality and effectiveness markers of the ED improved during weekend days compared with workdays.

After-Hours Care↗
PubMed2004

Gamma hydroxybutirate use for sexual assault.

The use of gamma hydroxybutyrate (GHB) as a recreational drug has quickly spread among European young people during the past decade. Although it has been claimed that GHB can be potentially used to facilitate sexual assault, no case reports have been previously described. A case is described in which GHB was used with that criminal purpose and a review of previous literature is undertaken.

Adult↗
PubMed2004

Reversible inhibition of mitochondrial complex IV activity in PBMC following acute smoking.

Smoking causes a decrease of mitochondrial complex IV activity in chronic smokers. However, it is not known if this toxic effect is due to the acute effect of cigarette smoke itself or is a secondary phenomenon related to other smoking factors. The study assessed mitochondrial respiratory chain function in peripheral blood mononuclear cells of 15 healthy nonsmoker individuals before smoking (t0), immediately after smoking five cigarettes in 45 min (t1) and 24 h later (t2). Blood carboxyhaemoglobin (COHb) and carbon monoxide concentrations in exhaled air (COEA) were determined to ascertain smoke inhalation status. After acute smoking, COHb increased from 0.5 +/- 0.3% to 3.3 +/- 1.5%, and COEA from 2.9 +/- 2.5 to 26.1 +/- 9.9 ppm. Complex II and III enzyme activities did not change along the study. Complex IV activity showed a 23% inhibition at t1 but returned to initial (to) levels at t2. A decay in oxygen consumption was observed after the correction for mitochondrial content. Lipid peroxidation of cell membranes remained unchanged. Short-time smoking causes an acute and reversible mitochondrial complex IV inhibition in human mononuclear cells. These results suggest that smoke itself is one of the causes for the decrease of complex IV activity observed in chronic smokers.

Adult↗
PubMed2003

A high carbohydrate diet does not induce hyperglycaemia in a mitochondrial glycerol-3-phosphate dehydrogenase-deficient mouse.

AIMS/HYPOTHESIS: The electrons of the glycolysis-derived reduced form of NADH are transferred to mitochondria through the NADH shuttle system. There are two NADH shuttles: the glycerol phosphate and malate-aspartate shuttle. Mice with a targeted disruption of mitochondrial glycerol-3-phosphate dehydrogenase, a rate-limiting enzyme of the glycerol phosphate shuttle, are not diabetic and have normal islet glucose-induced secretion. In this study, we analyzed if environmental factors, such as a high carbohydrate diet could contribute to the development of Type 2 diabetes mellitus in mice with a specific defective genetic background. METHODS: The mice were fed with a high carbohydrate diet for 1 and 6 months, and several biochemical parameters were analysed. The mitochondrial respiratory activity was assayed by polarography; and the islet function was studied by islet perifusion and pancreas perfusion. RESULTS: The high carbohydrate diet induced hyperglycaemia, hyperinsulinaemia, and islet hyperplasia in the wild-type and heterozygote mice. Activity of the respiratory chain complex I also increased in these mice. In contrast, these effects were not observed in the null mice fed with the diet; in addition, these null mice had an increased insulin sensitivity compared to wild-type mice. CONCLUSION/INTERPRETATION: The phenotype of the mice with an impairment of NADH shuttles does not worsen when fed a high carbohydrate diet; moreover, the diet does not compromise islet function.

Animals↗
PubMed2003

Cholinesterase inhibitor rivastigmine enhance the mitochondrial electron transport chain in lymphocytes of patients with Alzheimer's disease.

Electron transport chain (ETC) dysfunction has been claimed to contribute to the expression of neurodegenerative disorders. We have investigated the effects of the treatment with rivastigmine, a commonly used cholinesterase inhibitor, on lymphocyte mitochondria of patients with Alzheimer's disease (AD). Increased enzymatic activities of diverse complexes and oxidative capacity of the ETC were found. Enhanced mitochondrial ETC function may contribute to the beneficial effects of rivastigmine on clinical manifestations of AD.

Aged↗
PubMed2003

Analysis of patient flow in the emergency department and the effect of an extensive reorganisation.

OBJECTIVES: To evaluate the different internal factors influencing patient flow, effectiveness, and overcrowding in the emergency department (ED), as well as the effects of ED reorganisation on these indicators. METHODS: The study compared measurements at regular intervals of three hours of patient arrivals and patient flow between two comparable periods (from 10 February to 2 March) of 1999 and 2000. In between, a structural and staff reorganisation of ED was undertaken. The main reason for each patient remaining in ED was recorded and allocated to one of four groups: (1) factors related to ED itself; (2) factors related to ED-hospital interrelation; (3) factors related to hospital itself; and (4) factors related to neither ED nor hospital. The study measured the number of patients waiting to be seen and the waiting time to be seen as effectiveness markers, as well as the percentage of time that ED was overcrowded, as judged by numerical and functional criteria. RESULTS: Effectiveness of ED was closely related with some ED related and hospital related factors. After the reorganisation, patients who remained in ED because of hospital related or non-ED-non-hospital related factors decreased. ED reorganisation reduced the number of patients waiting to be seen from 5.8 to 2.5 (p<0.001) and waiting time from 87 to 24 minutes (p<0.001). Before the reorganisation, 31% and 48% of the time was considered to be overcrowded in numerical and functional terms respectively. After the reorganisation, these figures were reduced to 8% and 15% respectively (p<0.001 for both). CONCLUSIONS: ED effectiveness and overcrowding are not only determined by external pressure, but also by internal factors. Measurement of patient flow across ED has proved useful in detecting these factors and in being used to plan an ED reorganisation.

Analysis of Variance↗
PubMed2002

Short-term effectiveness of ceftriaxone single dose in the initial treatment of acute uncomplicated pyelonephritis in women. A randomised controlled trial.

OBJECTIVE: To compare the short-term effectiveness of ceftriaxone single dose followed by cefixime with a standard treatment of acute uncomplicated pyelonephritis in women. METHODS: An open, prospective, and randomised trial of women with acute uncomplicated pyelonephritis was performed. Group A were given a daily intravenous dose of 1 g ceftriaxone; group B: ceftriaxone 1 g intravenous single dose followed by oral cefixime. When urine culture was received, both groups completed a 10 day treatment based in sensitivity studies. Only women with positive initial urine culture were included. After three days of treatment, clinical and bacteriological efficacy was assessed. Clinical response was classified as "cured" if acute symptoms (fever, urinary syndrome and flank pain) were settled. Bacteriological response was classified as: eradication, or no eradication. RESULTS: Of 144 eligible patients, urine culture was positive in 54 of 72 (75%) women in group A and 51 of 72 (71%) in group B. There were no significant differences between groups in resolution of acute symptoms. Clinical cure was observed in 49 of 54 (91%) patients in the group A and in 47 of 51 (92%) patients in the group B (p = 0.68). After three days of treatment urine culture was negative for all patients. No adverse effects were observed in either of the groups. CONCLUSION: These data suggest that a intravenous single dose of ceftriaxone followed by oral cefixime is both effective and safe for the initial treatment of acute uncomplicated pyelonephritis in women. This regimen could be useful in managing selected patients with pyelonephritis as outpatients.

Acute Disease↗
PubMed2001

Mitochondrial involvement in antiretroviral therapy-related lipodystrophy.

OBJECTIVES: The management of HIV infection has greatly improved during recent years essentially because of the appearance of new antiretroviral drugs. Highly active antiretroviral therapy (HAART) has achieved important reductions of viraemia and significant recoveries of CD4(+) cell counts in HIV-infected patients. Nonetheless, cases of HIV-infected individuals experiencing lipodystrophy (LD) are being increasingly reported. The purpose of this work was to analyse whether the presence of mitochondrial abnormalities is a frequent feature in LD, since we previously detected mitochondrial abnormalities in an HIV-patient. The second main objective was to study whether LD could be associated with a specific drug. DESIGN: Seven HIV patients presenting LD and five HIV non-LD controls participated in the study. LD patients met the following criteria: (1) LD was their only clinical abnormality, (2) LD was clinically relevant, (3) compliance with antiretroviral treatment was higher than 90% and (4) patients did not have personal or familial history suggestive of mitochondrial disease or neuromuscular disorder. METHODS: Histological stainings, histo-enzymatic reactions, enzymatic and respiratory activities of mitochondrial respiratory chain complexes, and mitochondrial DNA (mtDNA) depletion and rearrangements were examined on muscle mitochondria. RESULTS: Structural muscle abnormalities, mitochondrial respiratory chain dysfunction or mtDNA deletions were detected in all HIV lipodystrophic patients. CONCLUSIONS: The mitochondrial abnormalities found suggest that mitochondrial dysfunction could play a role in the development of antiretroviral therapy-related lipodystrophy.

Adult↗
PubMed2001

[Quality assessment in Emergency Department: behavior respect to attendance demand].

BACKGROUND: We sought to evaluate whether the quality markers used to assess the outcomes of emergency care are modified by emergency department (ED) overcrowding. PATIENTS AND METHOD: The study was performed during 4 consecutive years (208 weeks) at the Internal Medicine Unit (IMU) of ED of a third level urban hospital. To quantify attendance requirement we used the number of weekly visits to the IMU as marker. The markers used to quantify quality of care were the weekly percentage of the following: a) patients who leave ED the department without being seen by a physician (LWBS); b) those who leave ED against medical advice (AMA); c) return visits to the department before 72 hours of previous discharge (revisited, R), and d) those who died in the IMU (dead, D). We quantified also the percentage of registered complaints (C). We considered the use of the IMU to be adequate when less than 700 patients/week, to be excessive if was between 701 and 800, and to have the overcrowded IMU if was more than 800. RESULTS: We registered a mean of 723 (60) weekly visits. LWBS, AMA, R, D and C indexes were 0.90% (CI: 0.76-1.03%), 0.19% (CI: 0.15-0.22%), 1.77% (CI: 1.69-1.86%), 0-87% (CI: 0.80-0.91%) and 0.24% (CI: 0.21-0.27%), respectively. In 38% of weeks the use of the IMU was adequate, in 51% was excessive, and in 11% was overcrowded. When we compared quality markers in relation to the level of occupation, we found a significant increase in LWBS, R and D indexes during the weeks of excessive occupation or overcrowding in relation to the weeks of adequate occupation (p < 0.0001; p < 0.0001, and p < 0.05, respectively). We also found a significant positive correlation between the number of weekly visits to IMU and LWBS, AMA R and D values (p < 0.0001; p = 0.002; p = 0.0001, and p < 0.05, respectively). CONCLUSION: ED overcrowding is associated to a decrease in the majority of quality markers.

Emergency Service, Hospital↗
PubMed2001

Acute quadriplegic myopathy with loss of thick (myosin) filaments following heart transplantation.

Acute quadriplegic myopathy with loss of thick (myosin) filaments (AQM-LTF) is an acute toxic myopathy observed in critically ill patients and is characterized by proximal or diffuse weakness of extremities and difficulty in weaning from mechanical ventilation. In recent years, this myopathy has been described in transplanted patients, although only 5 cases have been reported following heart transplantation. We present 3 new cases and review the previous literature. We conclude that the clinical picture and outcome of AQM-LTF in heart-transplanted patients do not differ from those observed in other critically ill patients (transplanted and non-transplanted). Therefore, because AQM-LTF is often clinically suspected muscle biopsy should be quickly performed to confirm the diagnosis so that physical therapy may begin as soon as possible.

Acute Disease↗
PubMed2001

Muscle angiogenic growth factor gene responses to exercise in chronic renal failure.

Patients with chronic renal failure (CRF) have impaired exercise capacity even after erythropoietin treatment. We recently showed that although this is explained in part by reduced convective O(2) delivery to muscles, there is also an impairment of O(2) transport from muscle capillaries to the mitochondria. Given the importance of the capillary surface area for capillary mitochondrial O(2) transport and reports of reduced capillarity in CRF, we hypothesized that the angiogenic gene response to exercise is impaired in such patients. Six patients with CRF and six control subjects matched for age, size, and sedentary lifestyle exercised on a single occasion for 1 h at similar work intensities averaging 50% of maximal capacity. Exercise was confined to the knee extensors of a single leg by means of a specially designed leg-kick ergometer. A percutaneous biopsy of the quadriceps was taken within 30 min of cessation of exercise and compared with a similar biopsy done at different times without any prior exercise for 24 h. Conventional Northern blots were prepared and probed for vascular endothelial growth factor (VEGF; the major putative angiogenic growth factor for muscle), basic fibroblast growth factor (bFGF), and transforming growth factor (TGF)-beta(1). Data during both rest and exercise were successfully obtained in four subjects of each group. We also assessed muscle capillarity and mitochondrial oxidative capacity to relate to these changes. Mitochondrial oxidative capacity was normal, whereas capillary number per fiber was 12% lower than in normal subjects. VEGF mRNA abundance was increased after exercise by about one order of magnitude, with no reduction in response in CRF. For bFGF and TGF-beta(1), exercise elicited no response in either group. Reduced muscle capillarity in CRF does not, therefore, stem from reduced transcription of VEGF. To the extent that VEGF is important to exercise-induced angiogenesis in muscle, we suspect a posttranscriptional aberration in this response occurs in CRF to explain reduced capillarity.

Adolescent↗
PubMed2000

[Relative effects of external and internal factors on emergency department efficiency].

BACKGROUND: To know the relative effect of external and internal factors on emergency department (ED) efficiency. PATIENTS AND METHOD: Along 3 consecutive weeks we compute at 3 hours-interval the number or patient waiting for visit and the mean waiting time for visit (efficiency markers), the number of patients arriving to ED (external pressure marker) and the number of patients remaining in ED after beginning the visit (internal pressure marker), which was divided in ED-related factors, hospital-related factors, ED-hospital interelation-related factors, or not caused by ED nor hospital-related factors. RESULTS: Only the increase of internal pressure was associated with a decline in ED efficiency (p < 0.001). ED-related and hospital-related factors were those significantly associated with such a decline (p < 0.05 and p < 0.01, respectively). CONCLUSION: Internal pressure generated by the own ED exerts a prominent role in its dysfunction; therefore, policies addressed to reduce such internal pressure should be encouraged.

Efficiency, Organizational↗