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Biomedical subjects

Pedro Ruiz

Publications and source records attributed to Pedro Ruiz.

17 recordsLinked to original sources
PubMed2007

Racial disparities in diagnosis and treatment of depression: a literature review.

The purpose of this study was to systematically review the literature to determine whether racial disparities exist in the diagnosis and treatment of depression in the United States. A literature search using PubMed of potentially relevant articles in English that include data from population-based studies examining the diagnosis and/or treatment of depression; or data from prospective studies stratifying the rates of diagnosis and/or treatment of depression by race/ethnicity and ethnic comparisons between Caucasians, African Americans and/or Hispanics. Initial searches identified 2,396 articles. On the basis of our criteria, 14 articles were eligible for inclusion in this review. Four included data on the diagnosis of depression in different ethnic groups; their results were not consistent. Twelve included data on treatment variability in the treatment of depression; overall these suggested lower rates of treatment for African Americans and Hispanics than for Caucasians. More research is needed focusing on ethnic variation in the diagnosis of depression. Racial disparities exist in the treatment of depression.

Black People↗
PubMed2006

Radiographic evidence of pulmonary edema during high-intensity interval training in women.

The purpose was to determine if an intense interval training session could produce transient pulmonary edema in women. Fourteen females [(27+/-4 years; body mass index of 21.6+/-1.5 kg/m(2)); maximal oxygen consumption = 3.12+/-0.42 L/min] performed three sets of 5 min sea-level cycling exercise with 10-min recovery between each set. Average oxygen consumption at minute 5 of each set was 96+/-5% of maximum and arterial plasma lactate concentration at minute 5 of each set was 16.0+/-3.3 mmol/L. Chest radiographs were obtained before and 33.2+/-6.1 min after exercise. Four different chest radiologists independently reviewed the radiographs for edema, and scored seven validated radiographic characteristics on a three-point scale (0-2). The overall edema score increased from 1.3+/-1.6 before exercise to 1.9+/-2.0 after exercise [P<0.05; Delta = +0.7+/-1.8, 95% CI, 0.2 to +1.1]. This study shows that an intense interval training session can cause mild, detectable pulmonary edema in some women.

Adult↗
PubMed2006

Pulmonary gas exchange does not worsen during repeat exercise in women.

The purposes were to determine (1) if repeat exercise worsens pulmonary gas exchange in women, and, (2) if the level of pulmonary edema obtained in these same women is related to the gas exchange impairment during exercise. Fourteen women (27 +/- 4 yrs; maximal oxygen uptake = 3.12 +/- 0.42 L/min) with minimal arterial PO2 (PaO2) ranging from 76 to 104 mmHg with a maximal alveolar-arterial PO2 difference (AaDO2) ranging from 7 to 35 mmHg performed three bouts of near-maximal exercise on a cycle ergometer (236 +/- 27 W) for 5 min each with 10 min of rest between sets. Cardiorespiratory parameters and oxygenation were measured at rest, throughout exercise and recovery. Chest radiographs were obtained before and 30 min after the interval training session (see Respir Physiol Neurobiol, 153 (2006) 181-190). Repeat exercise did not affect pulmonary gas exchange between sets 1 and 3 (change in PaO2 = 3 +/- 2 mmHg; change in AaDO2 = 1 +/- 2 mmHg P > 0.05). Arterial PCO2 decreased by 4 +/- 2 mmHg (P < 0.05) between sets 1 and 2, which did not reduce further in set 3. The level of PaO2 or AaDO2 was not related to the change in edema score or the post-exercise edema score (P > 0.05). In conclusion, pulmonary gas exchange is not worsened in women during interval training despite the mild edema triggered by exercise.

Adult↗
PubMed2006

Sequential lobar-lung-lobar isolation using a deflecting tip bronchial blocker.

This case report describes the use of a bronchial blocker (BB) with a wheel-controlled tip (Cohen flexitip endobronchial blocker) to provide initially middle and lower right lobe isolation and then right lung isolation (RLI) during right lower lobectomy in a patient with compromised pulmonary function preoperatively. As predicted, RLI and one-lung ventilation were associated with worsening oxygenation. Toward the end of the surgery, RLI was converted back to middle and lower right lobe isolation and oxygenation returned to normal levels. The BB design made lobar isolation easier and enabled repositioning of the BB during surgery. The techniques used for BB insertion as well as lobar and lung separation are described.

Aged, 80 and over↗
PubMed2005

Lung mechanics and gas exchange in one-lung ventilation following contralateral resection.

PURPOSE: To describe the anesthetic management of a patient with previous left lower lobe resection who was submitted to a right upper lobectomy and review the changes in gas exchange and respiratory mechanics which occurred intraoperatively. CLINICAL FEATURES: A 69-yr-old male with lung cancer, emphysema and obstructive sleep apnea, presented for a right upper lobectomy. His history was also positive for a left lower lobectomy six years previously. Intraoperative lung isolation was achieved using a 41 F left double-lumen tube (DLT). Monitoring the respiratory mechanics allowed for continuous adjustment of ventilator settings during the various phases of the surgery avoiding the risks of barotrauma and volutrauma. Problems with oxygenation occurred during one-lung ventilation. CONCLUSION: This case report shows that a severe level of hypoxemia and hypercarbia associated to lung mechanical property changes can be observed during the OLV phase. Application of continuous positive airway pressure on the non-dependent lung partially corrected blood oxygenation. Lobe isolation techniques should be considered as useful options for intraoperative airway management for these patients.

Aged↗
PubMed2005

[National project for the management of clinical processes. Surgical treatment of inguinal hernia].

INTRODUCTION: The high prevalence of surgical treatment for inguinal hernia (especially in general surgery) prompted the Spanish Association of Surgeons to perform a national study to identify the most important indicators. OBJECTIVE: To analyze healthcare quality in elective surgery for inguinal hernia by evaluating scientific-technical quality, efficiency, effectiveness, and patient satisfaction. MATERIAL AND METHODS: A prospective, longitudinal, descriptive study from diagnosis to postoperative follow-up was performed. Patients who underwent surgery for unilateral or bilateral, primary or recurrent inguinal hernias were included. Exclusion criteria were emergency surgery and associated surgical procedures. Clinical indicators were selected after a literature review. RESULTS: Forty-six hospitals corresponding to 16 Autonomous Communities with a total of 386 patients participated in this study. The mean follow-up was 18 months. The mean age of the patients was 56.33 years and 88.3% were male. Half the patients (50.1%) were American Society of Anesthesiologists (ASA) grade I. A total of 95.6% did not comply with the protocol for preoperative tests of the Spanish Association of Surgeons. Antibiotic prophylaxis was used in 75.39% and thromboembolic prophylaxis was used in 40.04%. Ambulatory surgery was performed in 33.6%. Local anesthesia and sedation only were used in 16.36% of the patients. The most frequently used surgical procedures involved mesh repair (Lichtenstein 50%, Rutkow-Robbins 17.1%), laparoscopy was used in 5.2% of the patients, and the Shouldice technique was used in 8.5%. The mean length of hospital stay was 47.5 hours in inpatients and was 11.65 hours in patients who underwent ambulatory surgery. Notable among the complications was hematoma in 11.6%. Ninety-six percent of the patients were satisfied or highly satisfied. The most highly scored items in the satisfaction survey were those related to information, personal dealings with staff, and the staffs kindness. The lowest scored items dealt with punctuality and accessibility. Follow-up at 18 months showed a recurrence rate of 4.11% with a total recovery time estimated by patients of 7.26 weeks. CONCLUSIONS: Analysis of the process revealed areas for improvement and strong points. Strong points consisted of up-to-date choice of surgical technique. The most frequently used techniques were tension-free procedures and the Shouldice technique. The following areas for improvement were identified: adherence to protocols for preoperative evaluation, increased use of ambulatory surgery, local anesthesia and sedation, appropriate use of antibiotic and thromboembolic prophylaxis in selected patients and a reduction in the length of hospital stay in inpatients. Patient satisfaction with the treatment was acceptable.

Adult↗
PubMed2003

The effect of isoflurane 0.6% on respiratory mechanics in anesthetized-paralyzed humans is not increased at concentrations of 0.9% and 1.2%.

PURPOSE: To assess the dose-dependent effect of low concentrations of isoflurane on respiratory mechanics in normal subjects. METHODS: We studied 12 non-premedicated ASA I patients scheduled for lower abdominal or extremity surgery. After thiopental 5-7 mg*kg(-1) iv and succinylcholine 1 mg x kg(-1) iv, the trachea was intubated and an esophageal balloon was placed optimally by the occlusion test. After introduction of N(2)O and muscle paralysis with vecuronium, we studied 0, 0.6, 0.9 and 1.2% isoflurane. We recorded flow (F), airway opening and esophageal pressures. Signals were amplified, filtered, sampled at 100 Hz, and then fed in a 12-bit analogue-digital converter in a personal computer. Data were collected and analyzed using LABDAT and ANADAT software. Signals were acquired for 60-90 sec during mechanical ventilation (10 mL x kg(-1), 10 breaths x min(-1), I:E ratio 1:2). We estimated respiratory system (RS), lung (L) and chest wall (W) dynamic elastance (E) and resistance (R) by P(t) = EV(T)(t) + RF(t) + K, where t is time, V(T) tidal volume from integration of F, and K an estimation of end-expiratory pressure. ANOVA was used for comparing the basal state with the three concentrations. RESULTS: E and R were statistically lower at 0.6, 0.9 and 1.2% compared to basal values for RS, L and W. Concentrations equal to or higher than 0.6% did not further change respiratory mechanics, except for E(L1.2) compared to E(L0.6,) 12.37 +/- 5.72 and 13.52 +/- 5.64 cm H(2)O.L(-1), respectively. CONCLUSION: Isoflurane concentrations between 0.6-1.2% are not associated to a dose-dependent effect on respiratory mechanics.

Analysis of Variance↗
PubMed2003

Outcome assessment of the Medicaid managed care program in Harris County (Houston).

Nowadays, managed care has taken over the management of the Medicaid program in most states of the nation. The patients treated in the public sector managed care system are very vulnerable and at high risk. Thus, we decided to measure the impact of managed care in the public-sector population of Texas. To this end, we assessed the treatment outcome at the Harris County Psychiatric Center (HCPC). Our results showed that after the implementation of the Medicaid managed care program in Houston, the bed utilization at HCPC decreased by 32% and the readmission rate increased by 21%; concomitantly, the length of stay decreased from 15.6 days to 9.3 days. Additionally, African-American and Hispanic-American patients were more negatively affected than Caucasian patients. Undoubtedly, the implementation of the Medicaid managed care system in Texas has led to untoward effects in the quality of care provided to the most disadvantaged population of the state.

Adult↗
PubMed2002

Hispanic access to health/mental health services.

Currently, the Hispanic population of the United States is growing very rapidly. Despite the significance of this growth and the fact that it is expected that Hispanics will be soon the largest ethnic minority group in this country, the access to health/mental health care for the Hispanic population is rather limited. Many factors are currently affecting the Hispanics' access to health/mental health care services. Among them, cultural and language barriers, insufficient numbers of Hispanic manpower in the health care professions, low educational and socioeconomic levels, the high number of uninsured Hispanics, and ethnic and racial prejudices and discrimination. In this commentary, I address the factors that interfere with the Hispanics' access to health/mental health care, and advance recommendations geared to alleviate and/or resolve this critical problem.

Forecasting↗
PubMed2002

Treatment with megestrol acetate improves human immunodeficiency virus-associated immune thrombocytopenia.

Splenic macrophage Fc gamma receptors participate in the pathophysiology of immune cytopenias, and in such disorders, the beneficial effects of glucocorticoids are in part mediated by decreased expression of macrophage Fc gamma receptors. In the animal model, progesterones, like glucocorticoids, inhibit expression of these receptors. Megestrol acetate (MA) is a progesterone frequently used for treating human immunodeficiency virus (HIV)-associated anorexia-cachexia. Twenty-eight patients with HIV-associated thrombocytopenia with shortened platelet survival and increased platelet-associated immunoglobulin G (IgG) who were being treated with MA for anorexia-cachexia were prospectively studied for a 6-month period to assess the potential role of progesterones in the treatment of immune thrombocytopenia. Treatment with MA for non-consecutive periods of 2 months and 1 month significantly increased platelet count and platelet survival without significant alteration of platelet-associated immunoglobulin levels. Of the 28 patients studied, 22 presented a complete response, 19 presented a complete response 1 month after finishing the MA treatment regimen, and 12 remained in complete response for a further month. Expression of Fc gamma receptors (Fc gamma RI and Fc gamma RII) by peripheral blood monocytes and the in vitro recognition of IgG-sensitized cells by monocytes were significantly decreased by the MA treatment. Decreased expression and functioning of these receptors significantly correlated with platelet counts and survival times, but no relationship was found with platelet-associated immunoglobulin, circulating immune complexes, body mass index, plasma HIV load, or CD4 lymphocyte levels. These results suggest that treatment with progesterones, like MA, may be an alternative therapy for immune cytopenias, with few side effects.

Adult↗