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Biomedical subjects

R Muñiz

Publications and source records attributed to R Muñiz.

At least 19 recordsLinked to original sources
PubMed2004

Benefits of cognitive-motor intervention in MCI and mild to moderate Alzheimer disease.

OBJECTIVE: To evaluate the efficacy of a cognitive-motor program in patients with early Alzheimer disease (AD) who are treated with a cholinesterase inhibitor (ChEI). METHODS: Patients with mild cognitive impairment (MCI) (12), mild AD (48), and moderate AD (24) (Global Deterioration Scale stages 3, 4, and 5) were randomized to receive psychosocial support plus cognitive-motor intervention (experimental group) or psychosocial support alone (control group). Cognitive-motor intervention (CMI) consisted of a 1-year structured program of 103 sessions of cognitive exercises, plus social and psychomotor activities. The primary efficacy measure was the cognitive subscale of the AD Assessment Scale (ADAS-cog). Secondary efficacy measures were the Mini-Mental State Examination, the Functional Activities Questionnaire, and the Geriatric Depression Scale. Evaluations were conducted at 1, 3, 6, and 12 months by blinded evaluators. RESULTS: Patients in the CMI group maintained cognitive status at month 6, whereas patients in the control group had significantly declined at that time. Cognitive response was higher in the patients with fewer years of formal education. In addition, more patients in the experimental group maintained or improved their affective status at month 12 (experimental group, 75%; control group, 47%; p = 0.017). CONCLUSIONS: A long-term CMI in ChEI-treated early Alzheimer disease patients produced additional mood and cognitive benefits.

Aged↗
PubMed1997

[Validity and reliability of the migraine self-questionnaire Alcoi-1995].

INTRODUCTION: In epidemiological investigation valid, reliable means of diagnosing the illnesses studies are essential. OBJECTIVE: To validate the self-questionnaire 'Alcoi 1995' for the diagnosis of migraine. METHODS: We used the questionnaire Alcoi-1992 (which had been validated previously) to find the prevalence of migraine in homogeneous populations. After this, we selected the significant items to obtain a shorter, more specific questionnaire for diagnosis of migraine, which we called 'Alcoi 1995'. We selected a population of patients and healthy volunteers. The diagnosis of migraine (neurologist and self-questionnaire) was made on criteria of the International Headache Society (IHS, 1988). RESULTS: There were 71 persons included in the study, 40 patients (5 men and 35 women those average age was 39.7 +/- 14.4 years) and 31 healthy volunteers (15 men and 16 women with an average age of 36 +/- 14.4). The sensitivity, specificity, positive and negative predictive value, and the Kappa concordance index for migraine (100%, 100%, 100%, 100% and 1); migraine with no aura (75%, 100%, 100%, 86% and 0.79) and migraine with a typical aura (100%, 88%, 63%, 100% and 0.71) were calculated. CONCLUSIONS: Our results show a high degree of validity and reliability when the self-questionnaire is used for the diagnosis of migraine. It is a tool for use in epidemiological studies which is quick and easy to use, and is cheap.

Adult↗
PubMed1997

[Prevalence of migraine in a homogeneous population using the self-questionnaire 'Alcoi-1995'].

INTRODUCTION: There are numerous studies of the prevalence of migraine and very varied findings. Amongst the many reasons for this would seem to be the use of questionnaires for screening populations, absent or incorrect validation of these questionnaires and the use of impracticable diagnostic criteria. OBJECTIVE: To determine the prevalence of migraine in a homogeneous population using the self-questionnaire 'Alcoi 1995' which had previously been validated for the diagnosis of migraine. A self-questionnaire was given to all workers in the same company. Diagnostic criteria of the International Headache Society (IHS, 1988) were used for diagnosis of migraine. RESULTS: The study included 140 persons (43.6% men and 56.4% women with an average age of 26.7 +/- 4.8 years). There was a prevalence of headache and migraine (IC 95%): 90.8% (75.01-100) and 24.3% (16.3-32.3) respectively. The sex prevalence of headache and migraine was 88.5% (88.3-88.8) and 11.5% (3.4-19.4) for men and 34.2% (21.5-47) for women respectively. CONCLUSIONS: There are a large number of studies of the prevalence of migraine with wide variability in the figures obtained (1-2 at 35%). These variations depend on the population studied, age and sex sampled, diagnostic criteria used and the method employed in the survey. After validation of the questionnaire for diagnosis of migraine, this should be used in homogeneous populations before use in broad population studies. Our findings support the use of a suitably validated questionnaire as a useful method for the diagnosis of migraine in epidemiological studies.

Adolescent↗
PubMed1996

[Validation of Allen's scale for the diagnosis of stroke].

INTRODUCTION: The importance of cerebrovascular pathology demands the most exact and complete diagnosis possible, by general physical and neurological examination and complementary techniques including computerized tomography (CT). Without CT, diagnosis may be delayed, for which reason such authors as Allen have put forward scales which by means of diagnostic scoring distinguish between stroke types. AIM: To validate the Allen scale as opposed to CT scan in a series of patients suffering from haemorrhagic and ischaemic stroke. MATERIALS AND METHOD: Sixty-two consecutive hospitalized patients suffering from stroke were studied, who all underwent CT scan within fifteen days of admission. RESULTS: The group consisted of 62 patients, 33 males (53%) and 29 females (47%) having an average of 70.2 +/- 11.2 years. The most frequent type of stroke was ischaemic (63%) as opposed to haemorrhagic (37%). Globally for all strokes we obtained the following results: Sensitivity (S) = 61%, Specificity (Sp) = 40%, positive predictive value ( + PV) = 84% and negative predictive value (-PV) = 17%. For ischaemic stroke the results were as follows: S = 76%, Sp = 66%; +PV = 67% and -PV = 76%. Finally for haemorrhagic stroke the results were S = 43%; Sp = 100%; +PV = 100% and -PV = 75%. CONCLUSIONS: The Allen scale has not proved to be a valid instrument in stroke diagnosis due to its low sensitivity and specificity especially in cases of haemorrhagic stroke.

Aged↗
PubMed1996

[Comparative study of the stability of oral anticoagulant treatments (warfarin vs acenocoumarol)].

PURPOSE: To compare the stability of the effect of two oral anticoagulants, one of them (acenocoumarol) with a short half life and the other one with a long half life (warfarin) in patients in the stable phase of treatment (at least 2 months with treatment before entering the study). PATIENTS AND METHODS: During a year period (January-December 1993) a comparative study of two groups of 53 patients each was performed: group 1 patients were treated with warfarin and group 2 with acenocoumarol. Both groups were paired with respect to age, sex, diagnosis for anticoagulant therapy and desired therapeutic range (INR 3-4.5). The mean value of controls per patient, the dosage changes, the evolutive controls and the incidence of haemorrhagic and thromboembolic episodes were studied. RESULTS: The controls performed in group 1 were 728 in total with a mean value of 13.74 per patient and 800 in group 2 with a mean value of 15.09 per patient. A change in the dosage was performed in 214 controls in patients of group 1 and in 269 of group 2. Seventeen patients had 38 haemorrhagic episodes (2 major and 36 minor) in group 1, and 6 of group 2 had 20 episodes (2 major and 18 minor). Significant differences were observed in the mean value of controls (p = 0.04), the evolutive controls (p < 0.001), the global incidence of haemorrhages (p = 0.008) and incidence of minor ones (p = 0.006). No significant differences in dosage were observed. In both groups no thromboembolic episodes during the period of study were reported. CONCLUSIONS: Anticoagulant treatment with warfarin is more stable than with acenocoumarol. The total controls and the mean value of controls per patient are decreased. Nevertheless with warfarin we have observed a greater incidence of haemorrhagic episodes.

Adult↗
PubMed1995

Durability of the Carpentier-Edwards porcine bioprosthesis: role of age and valve position.

The durability (structural deterioration-free interval) after valve implantation with the first-generation Carpentier-Edwards porcine bioprosthesis has been investigated. From 1978 through 1984, 420 patients (175 male, 245 female) underwent valve replacement with the Carpentier-Edwards standard bioprosthesis. Mean age was 50.6 years (range, 13 to 77 years). Isolated mitral valve replacement (MVR) was performed in 198 patients (47.1%), aortic valve replacement (AVR) in 136 (32.4%), and double valve replacement (DVR) in 86 (20.5%). Hospital mortality was 32 patients (7.6%), 7.5% for MVR, 5.1% for AVR, and 11.6% for DVR. Mean follow-up was 10.8 years (range, 9 to 15 years) and is 96.2% completed. Reoperation for structural deterioration was required in 143 patients. Actuarial curve free from structural deterioration at 15 years is 33.0% +/- 6.5% for MVR, 62.0% +/- 5.1% for AVR, and 44.2% +/- 8.2% for DVR (p < 0.03). Durability of the CE bioprosthesis for MVR was 101.6 +/- 34.5 months, 92.9 +/- 26.4 for AVR, and 84.3 +/- 25.3 for DVR (p = not significant). The regression logistic analysis between age at the time of surgery and durability of the bioprosthesis showed no correlation for the MVR group, but with the following predictive formula for AVR and DVR groups of patients older than 30 years" durability = 46.05 + 0.818 x age, for AVR (r2 = 0.43); durability = 15.81 + 1.122 x age, for DVR (r2 = 0.52). In conclusion, we have found a significant difference in the behavior of the CE porcine bioprosthesis between the mitral and aortic position.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1994

[Lymphoma of the ocular adnexa].

Ocular adnexa are rarely involved in lymphomas. Four cases are reported of lymphoma involving the ocular adnexa. In two cases a previous systemic involvement existed or simultaneous to the ocular involvement; another patient had systemically a different histological pattern to that observed in the ocular region, and the fourth patient only had ocular region, and the fourth patient only had ocular symptoms; we therefore recorded two cases of primary ocular lymphoma. The lymphoma was located at the orbit in two cases and at the conjunctiva in the other two cases; the condition was bilateral in three cases. The most common symptom was exophtalmus; other major symptoms were diplopia and disturbances in ocular motility. The histological examination revealed three low grade lymphomas and one case of intermediate grade. Management of patients included radiotherapy and different chemotherapeutic regimens with a good response in all cases. A higher ocular relapse rate was observed in those patients with systemic involvement; in one primary case the condition resolved spontaneously. A review of the literature on clinical, diagnostic and therapeutic issues is made.

Adult↗
PubMed1994

[Treatment with oral anticoagulants (acenocoumarol): influence of the initial doses in the incidence of hemorrhagic and thromboembolic episodes].

PURPOSE: To compare two initial doses of oral anticoagulant (acenocoumarin) studying the haemorrhagic and thromboembolic episodes occurred during the first month of treatment, the mean time and necessary controls until achievement of the desired level of anticoagulation. PATIENTS AND METHODS: From january 1992 to december 1993; a comparative study of two groups of patients was performed: group 1, compiling 129 patients chosen at random and retrospectively, who begun oral anticoagulant treatment with 4 daily mg of acenocoumarin; and group 2, compiling 129 patients chosen prospectively, who begun with 2 mg daily. In both groups the mean time and the number of controls performed until achieving the desired level of anticoagulation were analyzed, as well as the haemorrhagic episodes occurred during the first month of treatment, their severity (classified into major and minor ones), the level of anticoagulation when they occurred and their possible causes. In the same way the thromboembolic processes occurred during that period in both groups were studied. RESULTS: The mean time necessary to achieve the desired level of anticoagulation was 3.8 days in group 1 and 6.3 in group 2; the mean number of controls performed in group 1 was 1.2 and in group 2 it was 1.8. We have observed 19 haemorrhagic episodes, 15 in group 1 (4 minor and 11 major); and 4 in group 2 (2 minor and 2 major). We have found significant differences with respect to the mean time (p < 0.01), number of controls (p < 0.01) and incidence of hemorrhages (p = 0.017) between groups 1 and 2. One thromboembolic episode was registered in each group: in group 1 a deep venous thrombosis and in group 2 a stroke. CONCLUSION: The initial daily doses of acenocoumarin of 2 mg is as effective as the 4 mg one in the prevention of thromboembolic episodes, with a significant reduction in the number of haemorrhages observed during the first month of treatment. However this produces a prolongation in the necessary mean time and more number of controls performed until the achievement of the desired level of anticoagulation.

Acenocoumarol↗
PubMed1994

[Human recombinant erythropoietin in the treatment of myelodysplastic syndromes anemia. Meta-analytic study].

PURPOSE: To study the usefulness of different published epidemiological and analytic parameters to decide the treatment with human recombinant erythropoietin (rHuEPO) of anaemic patients with myelodysplastic syndromes (MDS). PATIENTS AND METHODS: We have revised 10 published series compiling 115 patients, studying age, sex, initial diagnosis, route of administration and posology, criteria of response, duration of the study, dosis with the response was obtained, response according to initial diagnosis, duration of responses, and effect of the treatment on other hematopoietic series. We have made a comparison between responders and non-responders based on epidemiological and analytical parameters. RESULTS: We have compiled 115 patients with a rate of global response of 23.5%. We have not found significative differences between the route (s.c. or i.v.) or frequency of administration, however the number of responses was higher when rHuEPO was administered three times weekly. A great variability in the criteria of response was observed among the different studies. Most of studies have a duration of three months but we have observed significative differences in the number of responses when the study is longer. We have not found significative differences between responders and non-responders with respect to age, sex, used dosis, transfusional dependency and degree of transfusional dependency, basal serum erythropoietin, time since diagnosis, transfusional period, haemoglobin level among non-transfusion dependent patients and haemoglobin level among transfusion dependent patients. We have found significative differences with respect to initial diagnosis, a higher rate of responses was observed in the refractory anaemia with excess of blasts (RAEB) group. We have not found a higher rate of transformations into acute myeloid leukaemia (AML) among these patients. The effects of the treatment on other haematopoietic series can be considered as anecdotical. CONCLUSION: The different epidemiological and analytic parameters published up to now are not useful in the decision of including an anaemic patient with MDS in the treatment with rHuEPO. Those patients with RAEB can be benefited with the treatment with rHuEPO. The concomitant use of other cytokines could improve these results.

Anemia↗
PubMed1993

[Hemorrhagic complications in patients treated with oral anticoagulants].

PURPOSE: We have studied the haemorrhagic episodes occurred in patients treated with oral anticoagulants, with special reference to their type, frequency and severity and analyzing the risk factors that could influence in their production. PATIENTS AND METHODS: We carried out a retrospective study in 435 patients of the haemorrhagic episodes occurred since January 1989 to December 1991, determining in each one the prothrombin time expressed as INR, the time from the beginning of treatment, the patient's age and the known or underlying pathologies that could predispose to haemorrhage; depending on their severity these episodes were classified as moderate and major. RESULTS: We observed 50 haemorrhagic episodes in 50 patients (11.5%) which represents 7 x 100 patient/years, 30 (6.8% of the total patients or 4.2 x 100 patient-years) were moderate and 20 (4.5% of the total patients or 2.8 x 100 patient/years) were major. The mean age in patients with haemorrhage was 50.5 years. The incidence of hemorrhages in the first month of treatment was 60.8 x 100 patient/years; 9.4 x 100 patient/years in the period from the first month to the first year of treatment; and 3.6 x 100 patient/years in the period from the first year of treatment. The most frequent type of haemorrhage among the moderate ones was haematuria (46%) and among major ones digestive haemorrhages (26%). Depending on the coagulation level, 37 patients (66%) were within therapeutical range. Depending on patients' sex, the incidence was 23 (46%) males and 27 (54%) females. We observed at risk predisposing factors hypertension (18%), stroke (12%), hepatic disease (8%) and myocardial infarction (8%). CONCLUSION: We have found no relationship between haemorrhagic episodes and patients' age or sex. The risk of haemorrhage is higher at the beginning of the treatment and increases with the level of anticoagulation, which makes the beginning of treatment with lower doses more desirable, increasing them progressively until the desired level is achieved. Previous hypertension, stroke, hepatic disease and myocardial infarction are factors predisposing to haemorrhage.

Administration, Oral↗
PubMed1992

Familial hypokalemia-hypomagnesemia or Gitelman's syndrome: a further case.

A woman aged 33 years presented hypokalemia and hypomagnesemia associated with renal potassium and magnesium wasting. Her mean 24-hour urinary calcium excretion was strikingly low despite normocalcemia, normal creatinine clearance, normal serum PTH and calcitriol. Normal distal fractional chloride reabsorption [CH2O/(CH2O + CCl)] was noted during water load but was reduced during hypotonic saline infusion. In response to intravenous furosemide (1 mg/kg), the patient showed significant increments in sodium, chloride and magnesium excretion as well as abolition of hypocalciuria. The association of renal calcium transport from magnesium transport together with exaggerated natriuresis after furosemide suggests the presence of a defect in the distal tubule rather than in the loop of Henle. We propose that our patient is affected by the syndrome of primary renotubular hypomagnesemia-hypokalemia with hypocalciuria, known as Gitelman's syndrome.

Adult↗
PubMed1991

Neutral amino acid transport by isolated small intestinal cells from guinea pigs.

Neutral amino acid transport was examined by using isolated enterocytes. Cells transport L-alanine by at least three different mechanisms: two Na(+)-dependent systems (A and ASC) and one Na(+)-independent mechanism (system L), in addition to passive entry. System A was characterized acterized by measuring the Na(+)-dependent alpha-(methylamino)isobutyric acid (MeAIB) uptake. Na(+)-dependent MeAIB uptake was concentrative and saturable. Vmax was obtained at 80mM Na+ in the incubation medium and Kt app for Na+ was 21.5 mM. Kt app for MeAIB was 6.75 +/- 0.37 mM and the Vmax was 14.2 +/- 0.3 nmol.mg-1.min-1. System ASC was studied by evaluating the Na(+)-dependent L-alanine uptake, insensitive to MeAIB and inhibitable by L-serine and L-cysteine. Uptake by this mechanism was also concentrative and saturable. Maximal uptake was obtained with 80 mM Na+ in the incubation medium and Kt app for Na+ was 29.7 mM. Kt app for L-alanine was 7.02 +/- 0.61 mM and Vmax was 5.44 +/- 0.19 nmol.mg-1.min-1. The Na(+)-independent system L was studied by measuring cycloleucine uptake in Na(+)-free medium. It had a saturable and a nonsaturable component. Only the saturable component was concentrative; it was inhibited by 2-amino-2-norbornanecarboxylic acid and was capable of mediating exchange diffusion. Kt app for cycloleucine was 4.05 +/- 0.72 mM and the Vmax was 31.9 +/- 1.3 nmol.mg-1.min-1. These results confirm the existence of Na(+)-dependent systems A and ASC and Na(+)-independent system L in isolated enterocytes.

Alanine↗
PubMed1989

[The characteristics of arterial hypertension in the population of a preventive medicine service].

Of 2,115 persons who were submitted to a voluntary check-up, we found 10.6% suffering from hypertension and 16.2% with borderline hypertension, the latter group having been followed and the condition subsequently confirmed in 45.9% of the case. The prevalence increases with age. There were no prevailing differences found between rural and city populations. The prevalence is greater in self-employed persons that in salary workers and we would bring to the fore the higher prevalence in housewives (p less than 0.0005). 74.8% of the hypertensive patients knew of their situation but only 15.6% of them showed normal blood pressure at the following-up. Rarely 0.85% had severe hypertension and 3% had moderate hypertension.

Age Factors↗
PubMed1988

Renal leiomyosarcoma in a patient with tuberous sclerosis.

We report the case of a 16-year-old patient with tuberous sclerosis that presented as renal leiomyosarcoma. This is an exceptional form of presentation of this tumor. An angiomyolipoma has to be first suspected in this group of patients. If the diagnosis is not confirmed by the imaging studies, radical surgery is recommended.

Adolescent↗