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Biomedical subjects

Rogelio Pérez-Padilla

Publications and source records attributed to Rogelio Pérez-Padilla.

16 recordsLinked to original sources
PubMed2006

The effect of biomass burning on respiratory symptoms and lung function in rural Mexican women.

BACKGROUND: The use of biomass as a cooking fuel is commonplace in developing countries and has been associated with chronic bronchitis and obstructive airway disease. METHODS: A cross-sectional survey was done in the village of Solis, close to Mexico City. Lifelong nonsmoking women 38 yr of age or older (n=841) completed a questionnaire on respiratory symptoms and illnesses and on cooking fuel use, and performed spirometry in their homes. Particulate matter concentration was measured with a nephelometer in the kitchen for 1 h, while the subject was cooking. RESULTS: The peak indoor concentration of particulate matter (PM10, particles with a diameter of 10 microm or less) often exceeded 2 mg/m3. Compared with those cooking with gas, current use of a stove burning biomass fuel was associated with increased reporting of phlegm (27 vs. 9%) and reduced FEV1/FVC (79.9 vs. 82.8%). Levels of FEV1 were 81 ml lower and cough was more common (odds ratio, 1.7; 95% confidence interval, 1.0-2.8) in women from homes with higher PM10 concentrations. All women found with moderate airflow obstruction (Global Initiative for Chronic Obstructive Lung Disease stage II and above) were cooking with biomass stoves. CONCLUSION: Women cooking with biomass fuels have increased respiratory symptoms and a slight average reduction in lung function compared with those cooking with gas.

Adult↗
PubMed2006

Obesity among children residing in Mexico City and its impact on lung function: a comparison with Mexican-Americans.

BACKGROUND: The objective of the study was to describe the prevalence of obesity among Mexican children and its impact on ventilatory lung function. METHODS: We studied cross-sectionally 6784 students between 8 and 20 years of age attending schools located <2 km away from ten air pollution monitors located throughout metropolitan Mexico City. The comparison group was made up of 1924 Mexican-Americans of the same age, studied during the NHANES-III examination, which included information on spirometry and body mass index (BMI). RESULTS: Of all our subjects, 9.7% had a BMI >95(th) percentile of CDC growth charts (compared to 15.1% in Mexican-Americans) and 6.6% fulfilled the obesity criteria of the International Obesity Task Force (vs. 12.2%). Obesity was related to male gender, asthma and passive smoking. At the same height and gender, lung function was higher in Mexicans than in Mexican-Americans, perhaps due to altitude. In children 8-11 years of age, lung function increased in heavier subjects but, in older children and youths, function reached a plateau and decreased among children with highest BMI (inverted U pattern, seen in adults). CONCLUSIONS: Obesity is higher in Mexican-American children and youths than in Mexicans. Spirometric function is affected adversely by obesity, especially in young people.

Adolescent↗
PubMed2006

[Spirometric reference values in 5 large Latin American cities for subjects aged 40 years or over].

OBJECTIVE: In clinical practice, spirometry is a extremely useful test that requires strict quality control, an appropriate strategy for interpretation, and reliable reference values. The aim of this study was to report spirometric reference values for 5 cities in Latin America. PATIENTS AND METHODS: From data for 5315 subjects who had undergone spirometry in the PLATINO study in Caracas, Mexico City, Santiago, São Paulo, and Montevideo, we selected information for 906 (17%) individuals aged between 40 years and 90 years to provide reference values. The chosen subjects had never smoked, were asymptomatic, had not been diagnosed with lung disease, and were not obese. Multiple regression models were constructed with the following spirometric parameters: forced expiratory volume in 1 second (FEV1) and in 6 seconds (FEV6), peak expiratory flow, forced vital capacity (FVC), FEV1/FEV6, FEV1/FVC, and forced midexpiratory flow rate. Height, sex, and age were also included in the model. RESULTS: Average values for the subjects studied were similar to those for the white North American population and the Mexican-American population of the third National Health and Nutrition Examination Survey, but exceeded those of the black population of the same survey by 20%. CONCLUSIONS: The proposed reference values are an improvement on those currently available for Latin America because the participants were chosen by population sampling methods and standardized up-to-date methodology was used.

Adult↗
PubMed2006

The long-term stability of portable spirometers used in a multinational study of the prevalence of chronic obstructive pulmonary disease.

BACKGROUND: We report the performance of an ultrasound-based portable spirometer (EasyOne) used in a population-based survey of the prevalence of chronic obstructive pulmonary disease, conducted in 5 Latin American cities: São Paulo, Brazil; México City, México; Montevideo, Uruguay; Santiago, Chile; and Caracas, Venezuela (the Latin American COPD Prevalence Study [PLATINO]). METHODS: During the survey period (which ranged from 3 months to 6 months in the various locations) we collected daily calibration data from the 70 EasyOne spirometers used in the 5 survey cities. The calibrations were conducted with a 3-L syringe, and the calibration data were stored in the spirometer's database. RESULTS: Ninety-seven percent of the calibration volumes were within +/- 64 mL (2.1%) of the 3-L calibration signal. Excluding data from the first city studied (São Paulo), where one calibration syringe had to be replaced, 98% of the calibration checks were within +/- 50 mL (1.7%). The measured volume was affected only minimally by the syringe's peak flow or emptying time. CONCLUSION: In these 70 EasyOne spirometers neither calibration nor linearity changed during the study. Such calibration stability is a valuable feature in spirometry surveys and in the clinical setting.

Brazil↗
PubMed2005

Survival of patients with chronic obstructive pulmonary disease due to biomass smoke and tobacco.

RATIONALE: Women exposed chronically to biomass develop airflow limitation, as tobacco smokers do, but their clinical profile and survival have not been described in detail. OBJECTIVE: To determine the clinical profile, survival, and prognostic factors of chronic obstructive pulmonary disease associated with biomass exposure and tobacco smoking. METHODS: During a 7-yr period (1996-2003), a consecutive series of 520 patients were recruited and followed up at the COPD Clinic of the National Institute of Respiratory Diseases. Prognostic factors of survival were evaluated taking into account the interaction between sex and exposure. MEASUREMENTS: Spirometry, arterial blood gases and oxygen saturation, body mass index, exercise capacity, and health-related quality of life were performed at baseline. The main outcome was survival. MAIN RESULTS: A total of 481 patients were followed up. The patients in the biomass group, mainly women (84%), were older and shorter and had a greater body mass index than those in the tobacco group (p < 0.0001). Airflow obstruction was more severe in smokers (p < 0.001). Quality of life and distance walked showed similar abnormalities in both groups. In the multivariable Cox regression analysis including an interaction term exposure-sex, we found that age (relative risk [RR], 1.02; 95% confidence interval [CI], 1.02-1.07), FEV(1) as percentage of predicted (RR, 0.96; 95% CI, 0.96-0.99), body mass index (RR, 0.95; 95% CI, 0.90-1.01), and oxygen saturation (RR, 0.96; 95% CI, 0.92-0.99) were predictors of mortality but not exposure or sex. CONCLUSIONS: Women exposed domestically to biomass develop chronic obstructive pulmonary disease with clinical characteristics, quality of life, and increased mortality similar in degree to that of tobacco smokers.

Aged↗
PubMed2005

Prevalence of chronic obstructive pulmonary disease and associated factors: the PLATINO Study in São Paulo, Brazil.

Chronic obstructive pulmonary disease (COPD) is now a major public health concern; deaths attributable to COPD in Latin America have increased by 65.0% in the last decade. This study was aimed at evaluating COPD prevalence and associated factors in adults (> 40 years) living in Greater Metropolitan São Paulo, Brazil. The study is part of the Proyecto Latinoamericano de Investigación en Obstrucción Pulmonar (The PLATINO Project), a multi-center survey on COPD burden in Latin America, with São Paulo as the first center where the project has been carried out. A population-based sample was selected in multiple stages. Spirometry tests were performed in each subject pre- and post-bronchodilator and COPD was mainly defined as the ratio of forced expiratory volume to forced vital capacity below 70.0% (fixed ratio definition). Other spirometric criteria were also used for the diagnosis of COPD. COPD prevalence was 15.8% (95%CI: 13.5-18.1) using the fixed ratio definition. COPD was positively associated with age and smoking and inversely with body mass index. Utilization of different COPD spirometry criteria resulted in different percentages of COPD, but similar associated factors.

Adult↗
PubMed2005

Catheter-related septic thrombophlebitis of the great central veins successfully treated with low-dose streptokinase thrombolysis and antimicrobials.

BACKGROUND: Septic thrombophlebitis is an iatrogenic life-threatening disease associated with use of central venous devices and intravenous (IV) therapy. In cancer patients receiving chemotherapy, vein resection or surgical thrombectomy in large central venous lines is time-consuming, can delay administration of chemotherapy, and therefore can compromise tumor control. Experience with thrombolysis has been published for catheter-related thrombosis but for septic thrombosis, this experience is scarce. RESULTS: We describe three patients with cancer and septic thrombophlebitis of central veins caused by Staphylococcus aureus treated with catheter removal, thrombolysis, and intravenous (IV) antibiotics. In our reported cases, an initial bolus of 250,000 international units (IU) of streptokinase administered during the first h followed by an infusion of 20,000-40,000 IU/h for 24-36 h through a proximal peripheral vein was sufficient to dissolve the thrombus. After thrombolysis and parenteral antibiotic for 4-6 weeks the septic thrombosis due to Staphylococcus aureus solved in all cases. No surgical procedure was needed, and potential placement of a catheter in the same vein was permitted. CONCLUSION: Thrombolysis with streptokinase solved symptoms, cured infection, prevented embolus, and in all cases achieved complete thrombus lysis, avoiding permanent central-vein occlusion.

Journal Article↗
PubMed2005

Frequency and correlates of adverse events in a respiratory diseases hospital in Mexico city.

OBJECTIVES: To estimate the frequency of severe adverse events (AEs) during hospital stay as well as their type and correlates in a referral hospital for respiratory diseases, using methods similar to those used in the Harvard Medical Malpractice Study. DESIGN: Retrospective review of medical records in a stratified sample of 836 patients drawn from a total of 4,555 hospital admissions registered during the year 2001. SETTING: A referral tertiary-care hospital for patients with respiratory diseases located in Mexico City. MAIN OUTCOME MEASURES: Weighted prevalence of AEs and odds ratios for correlates. RESULTS: The overall weighted prevalence for AEs was 9.1% (95% confidence interval, 7.5 to 10.4%). Of these patients, 17% had a related transient disability, 52% had a prolonged hospital stay, and 26% had an AE that according to the reviewers contributed to their death. Of the total number of AEs, 74% were qualified as potentially preventable. Among all types of AEs, we identified as most relevant for a chest hospital the delayed surgical treatment of empyema, representing 11% of the total. CONCLUSIONS: The frequency of AEs in a tertiary-care respiratory hospital is similar to that reported in general hospitals. A strategy to improve the treatment of empyema is needed.

Adult↗
PubMed2003

Spirometric function in children of Mexico City compared to Mexican-American children.

We set out to describe the pattern of lung function growth in Mexican students from 8-20 years of age, using internationally accepted equipment and methodology, and to compare it to values reported for Mexican-American children. Out of a total of 6,803 students from primary school to high school studied cross-sectionally in the Mexico City metropolitan area, we selected 4,009 asymptomatic, nonobese, nonsmoker subjects to generate spirometric prediction equations. We describe regression equations for the main spirometric variables (log transformed) based on age, height, and weight, and separated for males and females. Spirometric function in the population studied was above that predicted for European (Quanjer et al. [1987] Pediatr Pulmonol 19:135-142) or Mexican-American children, for the same age, height, and gender. On average, forced expiratory volume in 1 sec (FEV(1)) in Mexican children was 9.5% above that of Europeans (Quanjer et al. [1987] Pediatr Pulmonol 19:135-142), 14% and 5% above Hispanics reported by (Coultas et al. [1988] Am Rev Respir Dis 138:1386-1392) and (Hsu et al. [1979] J Pediatr 95:14-23), respectively, and 5% above Mexican-Americans from the third National Health and Nutrition Examination Survey study. Similarly, FVC was 8%, 14%, 8%, and 5.6% above the figures predicted by the same authors. The largest errors of prediction of foreign equations occurred in extremely tall or short subjects, and therefore a single proportional adjustment is unfeasible.

Adolescent↗
PubMed2003

Spirometric variability in a longitudinal study of school-age children.

OBJECTIVES: To describe spirometric reproducibility in a longitudinal study of students from Mexico City, and also the frequency of subjects fulfilling quality criteria proposed for children. SUBJECTS AND METHODS: Three thousand three hundred forty-seven participants from the third through sixth grades of elementary school were recruited to perform biannual spirometry, yielding a maximum of seven evaluations and a total of 15,563 tests. Standard recommendations of the American Thoracic Society (ATS) were followed, using dry rolling-seal volume spirometers. RESULTS: During their first spirometric test, > 95% of the subjects fulfilled each of the quality criteria proposed by ATS for adults, though not all of them did so simultaneously. For example, only 72.4% obtained three acceptable maneuvers, reproducibility for FEV(1) and FVC to < 200 mL, and a small back-extrapolated volume that increased to 92.3% by the second test. Between phase 1 and phase 7 of the study, spirometry quality increased significantly, as a result of subject and technician training. Intratest and intertest (with a 6-month difference) spirometric variability was less in boys than in girls. Intratest variability was also lower in younger and taller subjects. Technicians contributed significantly to intratest and intertest variability, the latter decreasing if the same technician performed both evaluations. CONCLUSION: Children > 7 years old can fulfill ATS criteria of quality after the first spirometric evaluation. To maintain quality of spirometric tests in longitudinal studies of children, a strict control is required, especially of technician performance.

Adolescent↗
PubMedDate not supplied

Clinical predictors of sleep disordered breathing in children at moderate altitude.

BACKGROUND: Validated clinical indicators of sleep disordered breathing (SDB) in children are scarce and none generated at moderate altitude where hypoxemic complications could be frequent and oximetry evaluation might be very efficient. METHODS: A total of 158 children consecutively referred to a sleep clinic in Mexico City (2240 m) for suspected sleep apnea underwent clinical evaluation and nocturnal monitoring of pulse oximetry, snoring and body position. RESULTS: Mean age was 4.9 years (SD 2.5) and 68.4% were males. A total of 84% of children were found with more than five desaturations per hour (>/=4%) while 63% and 34% had more than 10 and 20 desaturations, respectively. Based on logistic regression models, age </=5 was the only predictor for more than five desaturations per hour (OR 4.5, 95% CI 1.6-12.6). Clinical predictors of more than 10 desaturations were age </=5 years (OR 4.0, 95% CI 1.9-8.8), obesity (OR 3.5, 95% CI 1.3-9.1), enlarged tonsils (OR 3.5, 95% CI 1.6-8.1) and male gender (OR 2.4, 95% CI 1.1-5.2). Witnessed apneas (OR 3.1, 95% CI 1.7-7.0), age </=5 years (OR 2.6; 95% CI 1.2-5.5), obesity (OR 2.4, 95% CI 1.0-5.6) and simultaneous enlargement of adenoids and tonsils predicted more than 20 desaturations (OR 2.4; 95% CI 1.0-5.8). CONCLUSIONS: Age, gender, witnessed apneas, enlarged tonsils or adenoids and obesity were clinical predictors of SDB in children referred to a sleep clinic at moderate altitude.

Adenoids↗
PubMedDate not supplied

Population distribution residing at different altitudes: implications for hypoxemia.

BACKGROUND: Hypoxemia can adversely affect health. The present study is aimed at estimating the prevalence of altitude-related low partial pressure of oxygen in arterial blood in Mexican population by means of census and geographic data. METHODS: Population, altitude, and characteristics of communities were obtained from the Mexican Institute of Statistics, Geography, and Informatics (INEGI). The population of each municipality (municipio) was assumed to have the same age distribution as that reported for the entire country. Partial pressure of oxygen in arterial blood (PaO(2)) was estimated from altitude and from a hypothetical alveolar-arterial oxygen gradient that increases with age. RESULTS: In Mexico, 3.95% of the population lives at altitudes 2,500 m above sea level. Census data for the year 1990 recount 3.6 million people distributed among 6,150 communities. Exposure to intermediate altitudes is considerable: one half of the Mexican population resides above 1,550 m, 32% above 2,000 m, 25% above 2,230 m, and 5% above 2,440 m. It was estimated that between 0.9 and 3.4% of the healthy population (between 800,000 and 3 million persons) have a resting PaO(2) <55 torr, a criterion frequently used for prescribing chronic oxygen therapy in patients with lung diseases. CONCLUSIONS; Although the exact prevalence of hypoxemia in Mexico awaits empirical data, a large number of people live in places where altitude may expose them to low partial pressure of oxygen in inspired air. Ensuing hypoxemia may adversely affect their health. Hypoxia may be particularly harmful to elderly persons and to patients suffering from respiratory diseases.

Adolescent↗
PubMedDate not supplied

Normal breathing during sleep at an altitude of 2240 meters.

BACKGROUND: Mexico City is located at an altitude of 2240 meters (m) above sea level with a mean barometric pressure of 585 mmHg. Normal PaO2 and PaCO2 values in young subjects are 67 and 31 mmHg, respectively. Sleep desaturation, present in normal subjects at sea level, may be more frequent and severe at moderate altitudes. Our objective was to describe breathing during sleep in normal residents at an altitude of 2240 m above sea level. METHODS: Non-obese, long-term residents of Mexico City with normal pulmonary function and without sleep-related symptoms completed a nocturnal polysomnogram. RESULTS: A total of 23 subjects (12 males and 11 females) were studied. Mean age was 45 years (range 20-76 years). Seven subjects (four >60 years of age) presented sleep-disordered breathing (SDB) with apnea-hypopnea index >or=5 h(-1). Mean SaO2 during sleep was 93 +/- 2% and in all subjects was >or=90%. Five subjects without SDB monitored for PO2 tc maintained values of PO2 tc <60 mmHg during one half of the night. During sleep, mean PCO2et was 35 +/- 3 mmHg, breathing frequency 16 +/- 3, and heart rate 65 +/- 9. These values were maintained throughout sleep stages. CONCLUSIONS: Normal long-term residents of Mexico City had slightly lower mean oxygen saturation than that at sea level but >or=90% saturation and experienced transient desaturations. Breathing frequency and heart rate were similar to residents at sea level.

Adult↗
PubMedDate not supplied

[Breathing during sleep in patients with chronic obstructive pulmonary disease at an altitude of 2,240 meters].

INTRODUCTION: Patients with chronic obstructive pulmonary disease (COPD) dwellers of Mexico City may present a significant hypoxemia as a consequence of the lung disease and the altitude (2,240 m). These patients usually show a poorer hypoxemia during sleep. OBJECTIVE: To describe breathing during sleep in COPD patients residing at the altitude of Mexico City and the effect of supplementary oxygen. METHODS: A total of thirteen patients with COPD underwent standard polysomnography during two consecutive nights breathing room air or oxygen. Nine normal non-obese subjects matched by age and gender were also studied during one night breathing room air. RESULTS: Mean SaO2 during sleep was significantly lower in patients than in controls (85 +/- 5 vs. 93 +/- 2, p < 0.001). Oxygen desaturation was reversed with supplementary oxygen in all patients. However, sleep parameters were not different in patients and controls and did not change with oxygen. COPD patients were thachypneic in all sleep stages (18-20 vs. 13-14; p < 0.001) and this tachypnea persisted with oxygen. CONCLUSION: A substantial nighttime desaturation was corrected with oxygen in all COPD patients studied at this altitude. Nonetheless, sleep quality was similar in patients and controls and did not change when patients breathed oxygen.

Altitude↗
PubMedDate not supplied

[Precision and accuracy of "a pocket" pulse oximeter in Mexico City].

BACKGROUND: Pulse oximeters are frequently used in the clinical practice and we must known their precision and accuracy. The objective was to evaluate the precision and accuracy of a "pocket" pulse oximeter at an altitude of 2,240 m above sea level. METHODS: We tested miniature pulse oximeters (Onyx 9,500, Nonin Finger Pulse Oximeter) in 96 patients sent to the pulmonary laboratory for an arterial blood sample. Patients were tested with 5 pulse oximeters placed in each of the fingers of the hand oposite to that used for the arterial puncture. The gold standard was the oxygen saturation of the arterial blood sample. RESULTS: Blood samples had SaO2 of 87.2 +/- 11.0 (between 42.2 and 97.9%). Pulse oximeters had a mean error of 0.28 +/- 3.1%. SaO2 = (1.204 x SpO2) - 17.45966 (r = 0.92, p < 0.0001). Intraclass correlation coefficient between each of five pulse oximeters against the arterial blood standard ranged between 0.87 and 0.99. HbCO (2.4 +/- 0.6) did not affect the accuracy. CONCLUSIONS: The miniature oximeter Nonin is precise and accurate at 2,240 m of altitude. The observed levels of HbCO did not affect the performance of the equipment. The oximeter good performance, small size and low cost enhances its clinical usefulness.

Adult↗