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P Gayoso

Publications and source records attributed to P Gayoso.

17 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↗
PubMed2005

Comparison of two techniques of sputum induction in the diagnosis of pulmonary tuberculosis.

SETTING: Specialised tuberculosis out-patient clinic covering a population of 350 885. OBJECTIVES: To compare two techniques, ultrasonic nebuliser (UN) and Venturi-type face mask nebuliser (VFMN), for obtaining sputum in patients suspected of having active pulmonary tuberculosis (PTB) and who cannot expectorate, and to analyse the usefulness and cost of sputum induction with UN in a specialised medical practice. DESIGN: Prospective study from October 1997 until March 2000. RESULTS: Of 94 subjects who completed all tests, at least one sample of sputum was obtained from 89 (95.6%). UN provided adequate samples in 86 (93.4%) and VFMN in 66 (71%), a significant difference (P < 0.001). Among 43 patients diagnosed with active PTB, the diagnosis was confirmed in 39 with the samples obtained by sputum induction. Direct acid-fast bacilli smear was positive in 8 (19%). Direct costs were low and the technique can be performed on the day the patient attends the outpatient clinic. CONCLUSION: Sputum induction with an ultrasonic nebuliser was well-tolerated, of low cost, allows adequate samples to be obtained in the majority of patients who cannot produce sputum, and was more effective than the Venturi-type face mask.

Adolescent↗
PubMed2005

[Monitoring protocol of native vascular accesses for haemodialysis].

Vascular access failure is an important cause of morbidity and mortality for patients on haemodialysis. We have prospectively studied, with a 5 years follow up, a monitoring protocol of native vascular accesses, using the available methods in every haemodialysis unit. All the native vascular accesses, created from 1- 1998 to XII-2001, with a posterior follow up until XII-2002, were monitored. Monitoring was based on physical examination, dificulty for blood flow greater than 300 ml/min, and in a monthly basis: dynamic venous pressure, urea recirculation and urea kinetic model. Abnormalities suggestive of fistulogram were a priori defined. During the recruitment period, a total of 164 accesses were created in 144 patients. Of these only 3 were grafts, 28 native vascular accesses were never functioning (primary failure rate 17. 1%), and 127 native accesses created in 113 patients (age 63.3 +/- 12.4 years; 18 % diabetics), were monitored (83% cephalic vein). Monitoring findings indicated realization of fistulogram in 35% and percutaneus angioplasty in 25% of the accesses. In order to maintain patency, the surgical intervention rate was 0.03 procedures/patient/year, the radiological 0.10 and the total 0.13. During the 5 years of the study occurred 41 thrombosis episodes in 40 accesses (0.07 thrombosis/patient/year), with percutaneus repermeabilization in 30%. Primary (unassisted) survival was 30.3 months (Confidence Interval 95% 25.6, 35.0) and secondary (assisted) survival 42.8 months (Confidence Interval 95%: 38.7, 46.9). Logistic regression analysis showed that presence of a central catheter at the time of creating the vascular access posses a greater risk for thrombosis (Relative Risk 5.6 if in subclavian vein), whereas age, diabetes, time to canulation, number of previous accesses and anatomic type do not increase that risk. In conclusion, in an old haemodialysis population, with an important diabetes prevalence, it is possible to create functioning native vascular accesses in most of them. The monitoring protocol allowed the detection and posterior correction of stenosis in a great number of accesses. The main risk of thrombosis is the presence of a central catheter at the time of creating a vascular access.

Catheters, Indwelling↗
PubMed2005

[Occult chronic kidney disease (OCKD), and cardiovascular risk factors. Epidemiologic study].

UNLABELLED: Vascular diseases are the first cause of mortality within the occidental world. In Spain, they represent 35.5% within the total of deceases. Vascular diseases, jointly with Diabetic Nephropaty, are the first cause of inclusion of patients in dialysis. In precocious stages of renal disease, and as a consequence of the inflammatory condition generated already exists vascular damage. But its prevention is difficult, because habitually GFR is evaluated by means of plasmatic creatinin rate impeding the suitable detection of renal disease prevailing. OBJECTIVE: The purpose of this study is to evaluate the prevailing of Occult Chronic Kidney Disease (OCKD) and its association with conventional vascular risk factors (VRF). MATERIAL AND METHODS: The epidemiologic study was made in a randomly selected population elder than 18 years. GFR was calculated using Cockcroft-Gault and MDRD methods, and the results were correlated with VRF. RESULTS: The studied population mean age is 50.49 +/- 16.28 years, hypertension prevailing is 31.5%, diabetes: 7.5%, obesity: 21.9%, dislipènic: 35.62%, anemia: 1.4%. IV degree IRCO rate (GFR: 15-30 ml/min) is 0.7 (MDRD) with 69.43 +/- 12.58 years of age, and 1.5% (C-G) with 76.25 +/- 10.64 years of age. GFR, independently on the method used in its calculation, is significantly correlated with TAS (< 0.0001), pulse pressure (< 0.0001), Hb (0.0001), obesity (< 0.0001), Total Cholesterol (< 0.0001), triglycerides (< 0.0018), c-HDL (< 0.0001), c-LDL (< 0.0001) e hiperuricemic (< 0.0001). GFR disparity depends on the equation used. It could be explained because C-G overestimate by "weigh" and it has higher deviation in lower renal function values. Whereas, using MDRD equation there is an overestimation by "age" and it has lower variability. CONCLUSIONS: In an aged population, the prevailing of OCKD and the rate of VRF are high conferring high vascular risk. It will be necessary to adopt intervention measures in order to avoid renal disease progress and its high morbid-mortality.

Adult↗
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↗
PubMed2003

Neither folic nor folinic acid normalize homocysteine levels in hemodialysis patients.

AIMS: A greater decrease in total homocystein (tHcy) has been reported in patients on hemodialysis (HD) following the administration of reduced forms of folic acid (FA), however, the effect of the administration of moderated doses of oral levofolinic acid has not been compared with that of FA. We decided to perform a study to evaluate the therapeutic effectiveness of oral levofolinic acid, the pharmacologically active form of folinic acid in our population of HD patients already on treatment with oral FA and vitamin B6. MATERIAL AND METHODS: We undertook a prospective study in HD patients who had been receiving oral supplements of both FA 5 mg every 48 hours and vitamin B6 40 mg every 7 days during at least 6 months, with a 17% initial decrease of tHcy levels. Patients matched for age, sex and time on HD were assigned to 1 of 2 groups: Those in group A continued to receive their previous supplements while in group B, FA was substituted by calcium levofolinate 5 mg given orally every 48 hours. The following parameters were measured at baseline and at month 6: urea kinetic model and concentrations of plasma albumin, C-reactive protein, folate, vitamin B12, pyridoxal phosphate and tHcy. RESULTS: Group A: 30 patients aged 63.4 (57.9, 68.9) years, with a time on HD of 23.4 (15.8, 30.8) months, group B: 32 age-matched patients 66.2 (62.1, 70.3) years old, with a time on HD of 23.8 (16.7, 30.9) months. No differences were found either in folate levels (72.7 (47.9, 97.5) vs. 71.9 (44.0. 99.9) ng/ml), tHcy (23.5 (21.1, 25.9) vs. 23.3 (20.8, 25.8) micromol/l), or any other study variables. In the 2 groups a significant reduction in both residual renal function (RRF) and vitamin B12 levels was observed after supplementation, but no changes in tHcy values, folate levels or any of the other parameters were found. The prevalence of hyperhomocysteinemia in group A was 93.3% at study start and 100% at month 6, in group B the corresponding values were 93.8% and 96.9%. After 6 months, multiple regression analysis showed that tHcy levels were not influenced by the type of treatment (p = 0.543). CONCLUSIONS: After 6 months of calcium-levofolinate supplementation tHcy levels did not decrease and were similar to those in patients given the same dose of FA.

Aged↗
PubMed2002

Effect of long-term strength training on glucose metabolism. Implications for individual impact of high lean mass and high fat mass on relationship between BMI and insulin sensitivity.

The aim of this study was to examine the independent effect of high lean mass on glucose metabolism, as well as its consequences on the classic relationship between BMI and insulin sensitivity (SI) in 3 groups: 1) 8 strength-trained males with BMI >27 kg/m2 (athletes); 2) 10 sedentary males with BMI >27 kg/m2 (obese); and 3) 12 sedentary males with BMI 22-25 kg/m2 (control). Body composition was measured with impedance analysis. Iv glucose tolerance test was performed at 09:00 h after overnight fast. Estimation of insulin sensitivity and glucose effectiveness by Minimal Model Approach. Plasma glucose and insulin determination by glucose-oxidase and RIA respectively. BMI and lean mass (LM) were greater in athletes than in controls, but there were no differences in fat mass (FM), basal glucose (Gb), basal insulin (Ib), glucose tolerance (Kg), SI, glucose effectiveness (Sg), acute insulin response to glucose (AIRG) and leptin. Obese showed greater FM, leptin, lb and AIRG than athletes, while SI was lower; BMI, LM, Gb, Kg and Sg were similar. BMI, FM, LM, Ib, AIRG and leptin were lower in controls than in obese, while SI index was greater; Gb, Sg and Kg were similar. We found that: 1) Resistance exercise does not modify glucose effectiveness, but can improve insulin sensitivity through FM reduction (LM augmentation alone has no effect on glucose metabolism); and 2) High BMI causes insulin resistance only if it depends on adipose tissue hypertrophy.

Adipose Tissue↗
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↗
PubMed2001

[Prognostic factors of bacteremia: prospective study].

BACKGROUND: To identify the epidemiology and risk factors with influence in the outcome and mortality of a series of bacteriemic patients. MATERIAL AND METHODS: A prospective study of bloodstream infections with clinical significance detected in a secondary hospital of 650 beds over period from May 1998 to May 1999. The true bacteriemia was defined in basis to the criteria both the physician and microbiologist. A total of 16 variables were defined and categorized such as clinical-epidemiologic, intrinsic risk factor, extrinsic risk factor, outcome and survival. We used SPSS statistical package: For cuantitative variables we carried out with the mean with confidence interval of 95%, for cualitative variables: number and %. Univariate analysis of the results was carried out with the X2 test and t Student, the survival was expressed with Kaplan Meyer graphics and the logistic regression model. RESULTS: A total of 320 positive blood cultures were studied but only 272 blood cultures were considered true bacteriemia in 259 patients. The calculated incidence of significant episodes of bacteriemia per 1000 admissions/year was 13. The overall mortality was 22% whereas death attributable to bacteriemia was 16%. The mean age was 66.9 years (IC 95% 65-69), 59% episodes occurred in men. The 78% episodes occurred in patients hospitalized in medical services. 52% episodes were of nosocomial infection and 48% of community acquired infection. According to the severity of the underlying disease, 15% had fatal diseases and 35% episodes occurred in patients without underlying disease. According to the univariant analysis, the variables which where significantly associated with greater risk death were: etiology (fungus), septic shock, the inadequate antibiotic therapy, presence of extrinsic factors (central intravenous catheter, performance of invasive procedures, previous antimicrobial therapy) and the hospital stay of less than 10 days. According to the multivariable analysis showed that the factors remaining independent predictors of mortality were: septic shock (p < 0.0001, OR: 8), inadequate antimicrobial therapy (p < 0.005, OR: 6.7), existence of two or more extrinsic risk factors (p < 0.04). CONCLUSIONS: The presence of septic shock was the most important variable which influenced in the mortality in our serie, together with inappropriate antimicrobian therapy and the association of various extrinsic risk factors. These variables could be modified partly, for this reason the aggressive hemodynamic control and the early and appropriate antibiotic therapy would be the support of the successful bacteriemia management.

Aged↗
PubMed1998

[Sexuality and pregnancy].

OBJECTIVE: We intend to describe the sexual behaviour of pregnancies women. LOCATION: Family Planning Center Nóvoa Santos, of Galician Health Service (SERGAS), of Ourense (SPAIN). POPULATION: 206 pregnancies women that are attended in a obstetric psychoprophylaxis's programme, during two years (January/93-January/95). MEASUREMENT: We analysed the social economic, of reproduction, of medical attention and psycho-sexual variables. We use the PRESTA and SPSS statistics programmes. RESULTS: The average age is 28 years old, is married, has elementary studies and this is the first pregnancy. Her pregnancy is desire and normally developed. Her sexual desire and intercourse frequency is the same (1-2 per week); the intercourse is pleasant and the more habitual position is she over. Some times, the couple has relations without coitus and she practises the masturbation, and she enjoy of this practice. CONCLUSION: The pregnancies women have different sexual behaviours. They are satisfied with all them. The health' professional should favour the complete enjoy of the sexuality during the pregnancy.

Adult↗
PubMed1997

[The use and effects of postcoital contraception].

OBJECTIVES: To find those people seeking post-coital contraception (PCC), its efficacy and effects. DESIGN: A crossover study using a structured questionnaire, filled in both at the moment of demand and after using PCC. SETTING: The "Nóvoa Santos" Family Planning Centre in Ourense. PARTICIPANTS: All those requesting PCC between January 1995 and June 1996 (220 in all). INTERVENTIONS: The PCC norm was 8 pills, two taken every 12 hours, of 0.05 mg of Ethinyloestradiol (EE) plus 0.5 mg of Norgestrel. MEASURES AND MAIN RESULTS: We analysed social and demographic variables, sexual behaviour and PCC use with the SPSS programme for Windows. 96.4% attending were women, average age 21.98. They began coitus at 18.58 years old. 191 (86.8%) had a stable partner and 0 to 3 coitus per week. The condom was the commonest method (90.6%). CONCLUSIONS: Young women requesting PCC immediately after the risk coitus are students and residents in the city. It is a method used when there are problems with the condom and the frequency of failure is low. Sexually active people should be informed of the existence and use of PCC, as should the health professionals who could be asked for it.

Adult↗
PubMed1996

[Differentiated carcinoma of the thyroid gland in an area of endemic goiter. Clinical study and prognostic correlation].

OBJECTIVE: Differentiated thyroid Carcinoma is a relatively frequent malignant neoplasia with three histologic types: papillary, follicular, and Hürtle cell carcinoma. Although papillary is the most common type, in endemic goitre areas the frequency of follicular type increases. Up to now, the only European studies about clinical aspects of differentiated thyroid carcinoma in endemic goitre areas are those performed in the Bavarian region until 1983. As the province of Orense (assistance zone concerning to the Hospital Virgen del Cristal) is a zone of endemic goitre, we have analyzed clinical presentation features and prognostic correlation factors in patients with differentiated thyroid carcinoma living in this area. DESIGN: Retrospective study. Variables analyzed: 1) Age. 2) Sex. 3) Histologic type. 4) Tumor size. 5) Stage. 6) Presence of multinodular goitre. 7) Posttherapeutic disease persistence. 8) Recurrence. 9) Distant metastases. 10) Death attributed to thyroid carcinoma. PATIENTS: 61 cases of differentiated thyroid carcinoma, detected from 1983 to 1993. Mean follow-up period: 5 years (minimum 1, maximum 21). All patients were treated with total thyroidectomy followed by radioiodine ablation. RESULTS: 67.2% of papillary, 31.2% of follicular and 1.6% of Hürtle cell carcinoma. Male/female ratio: 1/4. Mean age: 48.8 +/- 2.9 (M +/- ESM) in papillary and 55 +/- 3.2 in follicular. Tumor size was smaller in papillary: 2.2 +/- 0.2 vs 6.2 +/- 0.5 cm (p < 0.001). Papillary type was detected more frequently than follicular in stages I, II and III, whereas follicular prevailed in stage IV (p < 0.03). Positive correlation between age and size in papillary: r = 0.393 (p < 0.01) and similar tendency in follicular: r = 0.423 (p = 0.057). Multinodular goitre was more frequent in follicular: 47% vs 25% (p = 0.02). Free of disease cases after treatment: 81% of papillary (p < 0.05) and 42% of follicular. Stage correlated independently with disease persistence after treatment (p = 0.0006). Age was minor in free of disease group: 50.0 +/- 3.8 vs 65.3 +/- 3.8 (p = 0.01). CONCLUSIONS: In our area, papillary is the most common type, but follicular proportion is higher than reported from non endemic goitre areas. PC is a small tumor detected in stage I, whereas FC is large and detected in stage IV. Tumor stage is an independent prognostic factor. Frequent presence of multinodular goitre in patients with differentiated thyroid carcinoma suggests that in zones of endemic goitre, clinical attitude in multinodular goitre and solitary nodule must be similar.

Age Factors↗
PubMedDate not supplied

[Effect of folic acid supplementation on total homocysteine levels in hemodialysis patients].

UNLABELLED: Hyperhomocysteinemia is an independent risk factor for cardiovascular mortality in ESRD, but about 80% of total homocysteine (tHcy) is bound to albumin (alb). We have tried, prospectively, to reduce tHcy levels by using folic acid (f.a.) and vitamin B6 (P.P.) supplementation. All patients on HD, not receiving f.a. or P.P. and all new patients, after their third month on HD, were supplemented with f.a. 5 mg/48 hours p.o and P.P. 40 mg/week. We determined folate, P.P. (RIA), vit. B12, KTV, residual renal function (KRU), PCRn, alb and tHcy levels (HPLC). 80 patients, age 62.6 +/- 13.6 years, time on HD 16.2 +/- 25.1 months, all dialysed with AN69 or PPMA, and bicarbonate, were included. The prevalence of hyperhomocysteinemia was 84.4%, and P.P. deficit was present in 32%, with folate in the low normal range. At the beginning of the study, before supplementation, tHcy was negatively correlating only with folate (r = -0.336) (p = 0.01), and not with P.P., vitamin B12, age, albumin, KTV, KRU or PCRn. 58 patients received six months of supplementation, with normalization of P.P. levels, a significant increase of folate (7.25; I.C = 95% confidence intervals: 6.45, 8.05 vs 61.29; I.C.: 44.47, 78.11) (p < 0.001), and decrease of tHcy (24.1; IC: 21.5, 26.3 vs 19.9; I.C: 17.5, 22.4) (p < 0.05). 33 patients have received 12 months of supplementation, but in spite of a continued increase of folate (100.78; I.C: 74.81, 126.74) (p < 0.001), only 3 have normal levels of tHcy; correlating directly tHcy with albumin (r = 0.56) (p = 0.001), that had increased compared to the beginning of the study (3.39; I.C. 3.29, 3.49 vs 3.50; I.C: 3.37, 3.63) (p < 0.05). CONCLUSION: After f.a. and P.P. supplementation, though initially tHcy is reduced, this response is short lived, and tHcy directly correlates with albumin levels. Good nutrition associated with HD adequacy, in absence of B vitamin deficits, seems to be the best determinant of tHcy levels rather than its removal by dialysis tHcy levels should be interpreted taking into account the serum albumin.

Aged↗