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R Poveda

Publications and source records attributed to R Poveda.

At least 19 recordsLinked to original sources
PubMed2005

Avascular jaw osteonecrosis in association with cancer chemotherapy: series of 10 cases.

BACKGROUND: We present a series of 10 patients with osteonecrosis of the jaws (ONJ) that appeared following cancer chemotherapy. MATERIAL AND METHODS: Of the 10 cases with ONJ, six had bone metastases from breast cancers and the other four had multiple myeloma. We analysed the location of bone metastases, as well as the characteristics of the ONJ, and the drugs with which they had been treated for their bone metastases. RESULTS: Of the 10 patients, all had ONJ in the mandible; 50% also had maxillary involvement. The average number of areas of painful exposed was 2.1 per patient (range 1-5). In seven patients a tooth extraction preceded the onset of ONJ. Two patients developed oroantral communications and another a cutaneous fistula to the neck with suppuration. In all the 10 patients the histopatholological diagnosis was of chronic osteomyelitis without evidence of metastatic disease to the jaws. All the patients had received treatment for their malignant bone disease with bisphosphonates. These were the only drugs that all patients had received. CONCLUSION: ONJ appears to have a relationship with the use of bisphosphonates.

Adult↗
PubMed2005

[Pharmacogenetics of angiotensin system in non diabetic nephropathy].

BACKGROUND: Genetic variability could contribute to the response to pharmacological treatment in patients with nephropathy. In albuminuric diabetic patients the renoprotective effect of angiotensin I-converting enzyme (ACE) inhibition should be lower among homozygotes for the deletion allele (DD) compared to II-homozygotes. METHODS: A total of 71 non-diabetic chronic nephropathy patients were treated with losartan (n = 37) or amlodipine (n = 34). Blood pressure and proteinuria were determined before and after the treatment, and changes in the mean values were statistically compared. Patients were genotyped for the ACE-I/D, angiotensin I receptor type 1 (AGTR1)-1166 A/C, and angiotensinogen (AGT)-M235T polymorphims, and the reduction of blood pressure and proteinuria between the different genotypes were compared. RESULTS: The reduction in systolic or diastolic blood pressure was not found to be different between the ACE-I/D or AGT-M/T genotypes in patients treated with losartan or amlodipine. In patients treated with losartan, we found a significantly higher reduction of diastolic blood pressure in AGTR1-AA patients compared to AC patients (p = 0,0024). We did not find differences in proteinuria-reduction between the different genotypes in patients treated with losartan or amlodipine. CONCLUSIONS: Our data show that the effects of losartan and amlodipine on the absolute mean reduction of blood pressure and proteinuria in non-diabetic nephropathy patients are similar between the different ACE or AGT genotypes. Although based on a small number of patients, the AGTR1-AA genotype was associated with a significantly higher reduction in diastolic blood pressure among losartan-treated patients. Additional studies are necessary to refute or confirm this association.

Adult↗
PubMed2000

Quantitative assessment of gait deviation: contribution to the objective measurement of disability.

Three biomechanical parameters based on force plate measurements were defined as indicators of gait deviation. Symmetry was specified as the relative difference in stance time and vertical impulse loading between both feet, constancy as the mean S.D. of the force curves for one subject under a specified gait condition and discrepancy as the average difference between the individual gait pattern and the expected force curves, normalised by the value of the S.D. in a control group. One hundred and forty four patients with osteoarthritis (OA) of the lower extremity and 144 control subjects were studied. There were 45 patients with OA of the hip, 54 of the knee and 45 of the ankle and their function was determined using the Harris Hip score, the hospital for special surgery knee score and the Mazur ankle score, respectively. The temporal asymmetry indicator was more sensitive to unilateral joint affliction, whereas the discrepancy indicators were sensitive to the presence of OA. Both correlated with the patient's function as measured by the relevant clinical score. A significant increase of gait discrepancy was detected in the arthritis group when patients were asked to walk at faster speeds; whilst walking barefoot led to an unexpected reduction of intra-subject kinetic variability. Our results confirm the validity and usefulness of the gait deviation concept in patients with OA.

Adolescent↗
PubMed1995

[Therapeutic immunoadsorption in Goodpasture disease].

The extraction of circulating antiglomerular basement membrane (GBM) antibodies by plasmapheresis (PP) has allowed the prognosis of Goodpasture's disease to markedly improve. Immunoabsorption (IA) may improve the results of PP upon allowing more effective immunoglobulin extraction. Two patients with Goodpasture disease were treated with IA. A rapid decrease was observed in the serum levels of anti GBM antibodies and improvement in respiratory failure. In one of the patients this regimen was administered following the observation of a lack of clinical response of pulmonary hemorrhage in three PP sessions (9 liters of treated plasma). In this patient, the IA processed 39 liters of plasma and the method was found to be equally effective on reinstatement (29 liters) on the occasion of a relapse in the pulmonary symptoms presented at three weeks after the first treatment. Both cases showed renal involvement. In one case this was incipient and the treatment was associated with non progression of the kidney disease, normalization of the urine sediment and preservation of renal function. In the second case treatment was initiated at an advanced disease state with no changes in dialysis needs. Immunoadsorption has shown to be effective in the treatment of pulmonary hemorrhage in Goodpasture's disease. Onset of treatment at an early stage of the kidney disease may avoid progression to renal failure.

Adult↗
PubMed1995

Interstitial nephritis in sarcoidosis: simultaneous multiorgan involvement.

Two cases of sarcoidosis with interstitial nephritis (lymphocytic and granulomatous) are described. In contrast to the majority of reported cases, patients simultaneously exhibited renal failure and multiple extrarenal manifestations, including bone marrow granulomas. Pretreatment gallium-67 gamma scan of the kidneys produced negative results. Patients were treated with steroids. Treatment resulted in a normal renal function after 1 year in the patient with lymphocytic interstitial nephritis. Renal function improved in the patient with granulomatous interstitial nephritis, and a second renal biopsy performed 13 months after diagnosis revealed granuloma disappearance and residual interstitial fibrosis. These cases provide evidence that interstitial nephritis in sarcoidosis may appear simultaneously with multiorgan involvement. The absence of gallium-67 renal intake does not guarantee that the disease is not active in the kidneys.

Female↗
PubMed1994

Neonatal sepsis and meningitis in a developing Latin American country.

In a retrospective study at Hospital del Niño in Panama City, Panama, 577 neonates with culture-proved sepsis and/or meningitis were identified during an 18-year period (1975 to 1992). Overall there was an incidence of 3.5 cases/1000 live births. Three hundred thirty-three patients (58%) were of low birth weight (< 2500 g) and 260 (45%) were premature. Gram-negative bacilli, particularly species of Klebsiella and Escherichia coli, were responsible for 61% of infections, whereas Gram-positive isolates (especially staphylococci) and Candida strains accounted for 37 and 2%, respectively. The patterns of predominance among bacterial pathogens, however, changed during the period of study. In the later years of this study the frequency of Gram-negative bacteria declined whereas those of staphylococci and Candida increased. Likewise systemic infections caused by Group B Streptococcus organisms appeared recently. The case-fatality rate was 32%. Mortality was greater in infants with early onset sepsis than in those with late infections (44% vs. 22%, P < 0.0001; odds ratio, 2.8; 95% confidence interval, 1.9 to 4.1) and lesser in neonates infected by coagulase-negative staphylococci than in those infected by any other pathogen (12 vs. 39%, P < 0.001; odds ratio, 0.2; 95% confidence interval, 0.1 to 0.4). These findings provide guidelines for the selection of empiric antimicrobial agents in our country and possibly in other Latin American countries and suggest that a continued thorough epidemiologic evaluation is needed to anticipate bacteriologic changes over time.

Candidiasis↗
PubMed1992

[Renal vasculitis without hematuria in senile patients].

Systemic vasculitis is a disease whose prognosis has improved considerably with steroid and immunosuppressive treatment, which points up the importance of early diagnosis. In elderly, diagnosis is made more difficult because the frequent onset in the form of a febrile syndrome with non-specific disturbances in general condition. In these patients it is not uncommon that a kidney involvement is what leads to diagnosis of the disease. Hematuria is almost a constant in vasculitis nephropathy. In their absence, acute renal failure in elderly is usually attributed to hemodynamic causes and the frequent presence of iatrogenic tubular factors. This is a report on the case of three elderly patients who presented a febrile syndrome with asthenia, anorexia and weight loss. The three cases progressed to acute renal failure with no disorders in urinary sediment. In two cases was a history of administration of gentamycin, indomethacin and iodated contrast. The clinical diagnosis was toxic and ischemic tubulopathy and, when dialysis became necessary, a renal biopsy was done which showed granulomatous vasculitis, intersticial nephritis and in two cases, necrotizing glomerulitis and crescent formation. Treatment with steroids and cyclophosphamide was started which improved general condition and renal function in one case. Early renal biopsy is advisable in senile patients with non specific systemic symptoms and progressive acute renal failure of unclear origin, even when hematuria is lacking. In this setting, the appearance of underdiagnosed renal vasculitis is possible, and consequent immunosuppressive treatment is a factor for consideration.

Acute Kidney Injury↗
PubMedDate not supplied

[Rapid-detection GBM-ANCA ELISA. An emergency tool for the early diagnosis of type I and II rapidly progressive glomerulonephritis].

Rapidly progressive glomerulonephritides (RPGN) are forms of necrotizing glomerulonephritis associated with anti-glomerular basement membrane (anti-GBM) and anti-neutrophil cytoplasmic antibodies (ANCA) against the antigens proteinase-3 (anti-PR3) and myeloperoxidase (anti-MPO). RPGN have a course of rapid progression to renal failure. We compared the results from the semiquantitative ELISAs for anti-GMB antibodies, PR3-ANCA and MPO-ANCA and the indirect immunofluorescence technique (IIF) against a new rapid assay (30 minutes) for the same antibodies in patients with clinically suspected RPGN. The semiquantitative ELISAs for anti-GBM antibodies and PR3-ANCA and MPO-ANCA have a proven diagnostic significance in patients with RPGN I and III. There were no significant differences between the ANCA-GBM screening test and the results from the semiquantitative ELISAs (p > 0.05). We did not find significant differences between the results for PR3-ANCA and MPO-ANCA from the ANCA-GBM screening test with C-ANCA and P-ANCA IIF values (p > 0.05). We also corroborated that the ANCA-GBM screening test is a diagnostic tool for RPGN I and III as useful as the semiquantitative ELISAs and the IFF technique. The ANCA-GBM ELISA screening test is a tool as useful as the semiquantitative ELISA against anti-GBM antibodies for diagnosis of RPGN I. The comparison of the screening ELISA with the IIF technique and the semiquantitative ELISAs against PR3-ANCA and MPO-ANCA showed similar utility for diagnosis of RPGN III. The advantages of the new screening assay are that three antibodies are tested at the same time, yielding results in only 30 minutes.

Adolescent↗
PubMedDate not supplied

[Anti-glomerular basement membrane antibody mediated disease: revision of 32 cases and follow-up at one year of the diagnosis].

Anti-basement membrane antibody mediated disease is an unfrequent entity but with a high mortality and morbidity. We present a revision of 32 patients diagnosed of anti-basement membrane antibody mediated disease between 1983 and 1997, and their evolution at one year of the diagnosis. The clinical pattern of presentation was as a Goodpasture's syndrome (glomerulonephritis and lung haemorrhage) in 15 patients and glomerulonephritis without lung involvement in 17. We reviewed retrospectively the features at the clinical presentation, the different treatments, and the delay of the starting of it since the beginning of the symptoms, in order to evaluate a prognosis dats of the disease. After the retrospective study we deduce that anti-basement membrane antibody mediated disease has a high mortality although the different regimes of treatment applied (25%), and the need of renal replacement therapy at one year of diagnosis is also high (70.8%). The renal survival at one year of the diagnosis is low and the response to therapy depends on the serum creatinine value at the diagnosis. The contribution of immunocompetent leucocytes to renal hypercellularity suggests that both humoral and cell-mediated immunity play a role in this disease.

Adolescent↗