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Ramon Pujol

Publications and source records attributed to Ramon Pujol.

14 recordsLinked to original sources
PubMed2006

Hospitalization due to acute heart failure. Role of the precipitating factors.

BACKGROUND AND AIMS: Many precipitating factors for decompensation of a chronic, stable heart failure (HF) have been described. OBJECTIVES: To evaluate the precipitating factors associated with HF decompensation among 293 patients admitted to a teaching hospital because of acute HF. RESULTS: 173 women and 120 men were included, and mean age was 76.7 years. In 221 patients (75%) there was some evidence of a factor that was potentially accountable for the decompensation of HF; a combination of two or more factors could be elicited in 100 patients. Except for a worse prior functional status, no differences were found between patients with and without identified precipitating factors. CONCLUSIONS: Precipitating factors may be identified in most patients suffering an acute episode of decompensation of HF. The majority of these factors appear to be preventable, and should thus be avoidable with a better, more comprehensive control of the HF patient.

Adult↗
PubMed2006

Predictors of in-hospital mortality present at admission among patients hospitalised because of decompensated heart failure.

Chronic heart failure (HF) is associated with a poor prognosis and causes considerable mortality. The aim of this study was to identify the admission characteristics useful to predict in-hospital mortality in patients admitted because of decompensation of HF. We evaluated 414 patients (age 76.2 years, 57% women). The hospital mortality rate was 11.1%. We identified 4 independent predictors of mortality: low Barthel index (odds ratio 1.03; 95% confidence interval 1.01-1.04), creatinine level >200 mumol/l (odds ratio 3.40; 95% confidence interval 1.51-7.66), peripheral oedema (odds ratio 3.12; 95% confidence interval 1.28-7.58) and the protective effect of the new onset of the disease (odds ratio 0.2; 95% confidence interval 0.08-0.77). In conclusion, the mortality of patients admitted to the hospital with an exacerbation of HF can be predicted if either poor functional capacity, renal insufficiency, peripheral oedema or previous diagnoses of HF are present. This clinical finding may help clinicians in their decision making in HF in the emergency room.

Aged↗
PubMed2006

Anemia in new-onset congestive heart failure inpatients admitted for acute decompensation.

BACKGROUND: Anemia may have important deleterious effects on patients with heart failure. We investigated the presence and causes of anemia among patients admitted because of new-onset congestive heart failure. The prognostic value of anemia was also evaluated. METHODS: We evaluated the presence of anemia, which was defined as hemoglobin concentrations lower than 13g/dl in men and lower than 12g/dl in women. One-year mortality and hospital readmission rates were also studied. RESULTS: A total of 103patients were included in the study. Their mean age was 78.5years and 53% were women. Mean hemoglobin levels were 12.4g/l. Forty-four patients (43%) had anemia at the time of hospital admission, 34 of them had true anemia and 10spurious anemia caused by hemodilution. Patients taking preadmission angiotensin-converting enzyme inhibitors had more severe anemia than those not taking them (p<0.01). The presence of anemia was not associated with an increase in mortality (p=0.3) or in readmission rates (p=0.1) after 1year of follow-up. CONCLUSIONS: Anemia is frequent in new-onset heart failure patients admitted for acute decompensation. However, the presence of anemia does not seem to be related to an increase in mortality or readmission in this small cohort.

Journal Article↗
PubMed2006

Significant reductions of HIV prevalence but not of hepatitis C virus infections in injection drug users from metropolitan Barcelona: 1987-2001.

OBJECTIVES: To characterize trends from 1987 to 2001 in the prevalence of HIV and HCV infections among 2219 injection drug users (IDUs) starting treatment for substance abuse in two large hospitals in metropolitan Barcelona. METHODS: The study population comprised IDUs with HIV tests completed from 1987 to 2001 and admitted for detoxification. Testing for HCV started in 1991 (n=1132). Characterization of temporal trends was carried out using logistic regression methods. Stratification was used to describe possible heterogeneities of the temporal trends. RESULTS: The overall prevalence of HIV, HCV, and HBV (HBsAg+) was 55%, 88%, and 7%, respectively. Adjusted by duration of IDU, sex, and age at initiation, the prevalence of HIV infection declined significantly (p<0.001) from 1989 to 2004. The substantially higher prevalence of HCV showed a decline (p=0.065) of lesser magnitude. The decline of HIV infection was consistently observed among those with duration of IDU of less than 10 years. In turn, the decline of HCV was restricted to those with short duration of IDU (<4 years) because the prevalence of HCV infection was close to 100% for durations longer than 4 years in all calendar periods. CONCLUSIONS: Preventive interventions and treatment for substance abuse might have contributed to the waning of the HIV epidemic in Spain. However, the extremely high levels of HCV infection and the underlying prevalence of HIV might lead to a large health burden of liver disease.

Adult↗
PubMed2006

[Functional assessment of elderly patients admitted for heart failure].

The aim of our study was to evaluate the usefulness of functional assessment in very old patients admitted for heart failure. We assessed 188 patients aged >79 years. Their mean age was 84.6 (3.5) years, and 67% were female. Twenty-five patients (13%) died. Mortality was higher in those with more severe disability, with more comorbid conditions (as determined by the Charlson index), and with a low hematocrit and a high creatinine level. Logistic regression analysis showed that the Barthel index, the Charlson index, and the serum creatinine level were statistically significant factors. Functional assessment may help in the identification of elderly patients at a higher risk of death following hospital admission for heart failure.

Aged, 80 and over↗
PubMed2005

Functional outcomes of elderly patients after the first hospital admission for decompensated heart failure (HF). A prospective study.

Congestive HF is one of the most common discharge medical diagnoses in elderly hospitalized patients. We evaluate prospectively the usefulness of a global geriatric assessment to identify changes in the functional status of patients who experience their first hospitalization for a new diagnosis of HF. The Barthel Index (BI), the Older Americans Resource Scale (OARS), the Short Portable Mental Status Questionnaire (SPMSQ), and the short form of the Mini Nutritional Assessment (short-MNA) were used to estimate functional, cognitive, and nutritional status. The Charlson score (CS) was used to measure comorbidity. Eighty-eight patients (mean age 79 years; 57% women) were finally included; their median CS score was 2.1. Prior to the index admission, their mean BI score was 91, OARS 9.8, SPMSQ 1.8 errors, and short-MNA 10.7. Twenty-four patients (27%) died during the first year of follow-up. Low preadmission BI scores were predictive of mortality (p=0.02), but not of readmission (p=0.9). After one-year of follow-up BI scores remained lower than preadmission values in 64% of the surviving patients; for OARS scores the figure was 67%. In conclusion, a previous low functional capacity is associated with higher mortality but not with HF-related hospital readmission. Admission because of a new onset HF is often followed by a sustained functional decline both for the performance of basic and instrumental activities of the daily living.

Activities of Daily Living↗
PubMed2005

[Predisposing factors of delirium in hip fractured patients older than 84 years].

BACKGROUND AND OBJECTIVE: Our objective was to analyze those factors predisposing to delirium in patients older than 84 years who were admitted because of hip fracture. We also compared the prevalence of delirium in this population with a younger group. PATIENTS AND METHOD: One hundred and thirty patients (mean age 91.8 years) and 50 controls aged 65 to 84 years were included. RESULTS: Forty-three patients (33%) developed delirium. A poor previous functional capacity was the best marker identifying those at risk for developing delirium. Although the prevalence of delirium was higher in those older than 84 years, statistically significant differences were not reached. CONCLUSIONS: Disability prior to admission is the main risk factor predisposing to delirium during hospitalization in patients older than 84 years who are admitted because of hip fracture.

Aged↗
PubMed2005

A folate-rich diet is as effective as folic acid from supplements in decreasing plasma homocysteine concentrations.

Background & Aims: At least 500 mug of folic acid are required daily to treat hyperhomocysteinemia. To reach this amount by dietary changes alone may be difficult because food has a low folic acid content and bioavailability. No studies have compared the effects of similar amounts of additional folate derived from a combination of folate-rich and fortified foods or folic acid from supplements on plasma total homocysteine (tHcy) concentrations, which was the aim of this study. Methods: Twenty male patients with hyperhomocysteinemia and coronary artery disease were included in a randomized, crossover intervention trial. Patients were treated daily with a combination of foods containing approximately 500 mug of folate or with one 500 mug capsule of synthetic folic acid over two five-week periods separated by a five-week wash-out period. Results: Plasma folate increased markedly (p<0.001) and plasma tHcy decreased (p<0.001) with both therapies. Folate-rich foods decreased tHcy by 8.6% (95% CI: -15.9 to -1.2) and synthetic folic acid capsules by 8% (95% CI: -13.3 to -2.7). Conclusions: This study shows, for the first time in the literature, that a folate-rich diet is as effective as folic acid capsules in decreasing plasma tHcy concentrations and adds further support to the recommendation of those diets to prevent cardiovascular disease.

Journal Article↗
PubMed2005

Influence of acute exacerbation of chronic obstructive pulmonary disease or congestive heart failure on functional decline after hospitalization in nonagenarian patients.

BACKGROUND: The functional decline that follows hospitalization may be especially important in frail populations such as nonagenarians. The present study examined the functional decline among nonagenarians admitted because of exacerbations of chronic obstructive pulmonary disease (COPD) or congestive heart failure (CHF). METHODS: A prospective cohort study was performed on two groups of patients who were distinguished by diagnosis in two tertiary academic medical hospitals. Sixty nonagenarian patients, admitted because of exacerbation of COPD (n=30) or CHF (n=30), were evaluated at admission, upon discharge, and 3 months post-hospitalization. The Barthel Index (BI) was used to assess functionality. The outcome we were interested in was functional decline 3 months after hospital discharge. RESULTS: The inpatient mortality rate was 10%. Overall functional status at discharge, as compared with that before admission, declined in all 54 surviving patients (p<0.001). At the 3-month follow-up, 37 patients were evaluated; a decline in their BI persisted in 60% of them. We did not find significant differences, either upon discharge or at 3 months post-hospitalization, in the decrease in BI rate between COPD patients and CHF patients. CONCLUSIONS: The fact that the underlying disease does not induce differences in the functional outcome of nonagenarians reinforces the importance of using a comprehensive approach at admission and after discharge for all frail patients.

Journal Article↗
PubMed2003

[Primary hyperhidrosis: prospective study in 338 patients].

BACKGROUND AND OBJECTIVE: The objective of this report is to study the clinical aspects of the patients with primary hyperhidrosis (PH) and the social and occupational distressing condition. PATIENTS AND METHOD: From January 1998 to October 2002, 338 patients with PH completed a preoperative questionnaire to register: age, gender, profession, associated diseases, familiar hyperhidrosis history, sweating location, associated dermatological lesions and social embarrassesment. 179 patients were asked about their general symptomatology. RESULTS: In 86% of the patients PH started during infancy, 71.5% were female (mean age 28.8 years). A few patients had others diseases and 42.5% had some associated dermatological lesions. In 47.9% of the patients there is family history of PH. 96.4% reported palmar hyperhidrosis, 80.7% plantar PH and 71.3% reported axillary PH, being less frequent in others regions of the body. The most frequent clinical founding associated is facial blushing in 60.3%, 52.3% heart palpitations, 48% muscle stress, 31.8% reported trembling of the hands and 30,8% headache. In reference to social embarrassesment, we observe that relations between friends and professional environment are the most problematic situation. CONCLUSIONS: PH is a pathologic condition starting in infancy, family history of PH is frequent and most patients have some associated dermatological lesions. Excessive sweating is especially common in palms but no exclusively of this region as it extends to others regions with the same intensity. It can be associated with symptomatology suggestive of hyperexcitability of the sympathetic activity like facial blushing, trembling or headache, symptoms difficult to consider whether they are cause or consequence.

Female↗
PubMed2003

[Secondary Preventive Program of atherosclerosis in a university hospital. Results and predictors of clinical course].

BACKGROUND AND OBJECTIVE: Lipid therapeutic goals are not achieved in a high percentage of patients with coronary artery disease (CAD). We describe in this paper the methodology and results of the Hospital Universitario de Bellvitge Atherosclerosis Secondary Preventive Program (PPSHB), which is aimed at preventing ischemic recurrences by controlling atherogenic factors. PATIENTS AND METHOD: From January 1992 to December 1996, 882 patients with acute CAD entered the PPSHB and were seen on at least 2 occasions at the Unidad de Lípidos y Arteriosclerosis during a mean period of 10.4 (3.8) months. In 753 patients data on clinical follow-up were available. Follow-up data were collected by telephone interview and review of medical records. RESULTS: During the follow-up period at the Unidad de Lípidos y Arteriosclerosis, 71.9% of patients achieved the therapeutic goals or their LDLc improved >= 15%. These results were seen in 83.6%, 78.7% and 83.6% of patients with regard to HDLc, triglycerides and HDLc/LDLc ratio, respectively, while the percentage of patients receiving lipid-lowering drugs increased from 28% to 69%. During a follow-up of 33.7 (15.9) months, death (all causes; mean survival time: 20 [13.4] months) occurred in 41 patients (5.4%). On the other hand, hospitalization for cardiovascular disease was required in 113 patients (15%) during a mean follow-up until the first admission of 18.4 (14.2) months. The main independent predictor of unfavourable clinical course was not to reach the HDLc/LDLc ratio goal (HDLc/LDLc >= 0.27 or an increase >= 15%; OR = 2.1; 95% CI, 1.1-4.03). CONCLUSIONS: A systematic secondary preventive strategy may help achieve an adequate control of dyslipidemia in most CAD patients. In these patients, achieving the HDLc/LDLc therapeutic goal is associated with a less than half risk of hospitalization for cardiovascular disease or death from any cause.

Adult↗
PubMed2002

Corticosteroid therapy increases HDL-cholesterol concentrations in patients with active sarcoidosis and hypoalphalipoproteinemia.

BACKGROUND: We have previously reported that the decrease in high-density lipoprotein (HDL)-cholesterol that is observed in patients with untreated sarcoidosis is limited to those with active disease. AIM: To determine the effect of corticosteroids, used in the treatment of active sarcoidosis, on the reported lipoprotein metabolism abnormalities. METHODS: We studied 62 patients with biopsy-proven sarcoidosis, all of them with active disease. Sarcoidosis activity was evaluated by means of clinical, chest X-ray, gallium-67 scan, serum angiotensin-converting enzyme (peptidyl-dipeptidase A) values, and pulmonary function tests. A total of 40 patients were not treated with prednisone and 22 patients were treated with prednisone. The mean daily prednisone dosage in the treated patients with sarcoidosis was 20 mg and the mean duration of prednisone therapy was 6 months. Analysis of lipoprotein metabolism included: serum cholesterol, low-density lipoprotein (LDL)-cholesterol, HDL-cholesterol, HDL(2)-cholesterol, HDL(3)-cholesterol, apolipoprotein (apo) A-I, apo B, and triglyceride concentrations. RESULTS: When patients with active sarcoidosis not treated with prednisone were compared to those treated with prednisone, the former had significantly lower HDL-cholesterol (1.17+/-0.36 vs. 1.42+/-0.42 mmol/l; P=0.01) and HDL(2)-cholesterol (0.37+/-0.18 vs. 0.53+/-0.25 mmol/l; P=0.009) levels. Multiple regression analysis demonstrated that the HDL-cholesterol (P=0.004), HDL(2)-cholesterol (P=0.002), HDL(3)-cholesterol (P=0.02), and apo A-I (P=0.02) levels were the variables independently and significantly associated with steroid therapy. CONCLUSIONS: Corticosteroid therapy, used in the treatment of active sarcoidosis, increased HDL-cholesterol levels to those seen in inactive disease. These changes are manifestations of reducing disease activity.

Adult↗