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Biomedical subjects

S Quintana

Publications and source records attributed to S Quintana.

At least 19 recordsLinked to original sources
PubMed2006

The bronchodilator test in chronic obstructive pulmonary disease: interpretation methods.

The objective of the study was to evaluate the best method for interpreting the bronchodilator test (BDT). Five formulas for expressing the BDT results were analyzed and compared: changes experienced by maximum expiratory volume in 1s (FEV(1)) and forced vital capacity (FVC) measured in milliliters, in percentage with respect to the baseline, in percentage with respect to the predicted, in percentage with respect to the possible, and in standardized residuals. Ninety-eight chronic obstructive pulmonary disease (COPD) patients were submitted to a respiratory function test on two different days. On each occasion three spirometries were conducted: basal, post-placebo and post bronchodilator. As a gold standard, a normality interval was defined using the variability experienced with the placebo between the two days of the study. The best formulas according to their sensitivity, specivity and area under receiver operating characteristic (ROC) curve were the "standardized residuals", with a cut point of .3, and the "percentage with respect to the predicted" with a cut point of 6%.

Aged↗
PubMed2005

Metastatic lymph node ratio as a prognostic factor in gastric cancer.

BACKGROUND: There is an association between the number of resected lymph node and the number of metastatic lymph nodes in gastric cancer, suggesting that pN category could be influenced by the extension of the lymphadenectomy. This study evaluates this association and proposes a comprehensive use of the ratio as prognostic factor. METHOD: Review of 183 consecutive patients with gastric adenocarcinoma. The association between the number of resected lymph nodes and the number of metastatic lymph nodes was analysed and evaluated with other prognostic factors. RESULTS: The number of lymph node metastases increased with the number of resected lymph nodes. The lymph node ratio was a better prognostic factor than the number of metastatic lymph nodes. CONCLUSIONS: The metastatic lymph node ratio seems to be a good prognostic factor, but needs further evaluation.

Adenocarcinoma↗
PubMed2004

An economic model of haemophilia in Mexico.

A model was developed to assess the lifetime costs and outcomes associated with haemophilia in Mexico. A retrospective chart review of 182 type A haemophiliacs was conducted for patients aged 0-34 years receiving one of three treatments: (i) cryoprecipitate at clinic; (ii) concentrate at home; or (iii) concentrate at clinic. Patients treated at home experienced 30% less joint damage, used 13-54% less factor VIII, had four times fewer clinic visits, and utilized half as many hospital days than those treated at a clinic. For cryoprecipitate at clinic patients, the annual incidence rates of HCV and HIV were calculated to be 3.6% and 1.4% respectively. The life expectancy for patients receiving cryoprecipitate and those receiving concentrate was estimated to be 49 years and 69 years respectively, with 58% of cryoprecipitate patients predicted to die of AIDS before age 69. Across the lifespan, the average annual cost of care was US$11,677 (MN$110,464) for cryoprecipitate at clinic patients, US$10,104 (M$95,580) for concentrate at home patients and US$18,819 (MN$178,027) for concentrate at clinic patients. Using a 5% discount rate, the incremental lifetime cost per year of life added for treatment with concentrate at home compared with cryoprecipitate at a clinic was US$738 (MN$6981). Rank order stability analysis demonstrated that the model was most sensitive to the cost of fVIII. These results indicate that treatment with concentrate at home compared with cryoprecipitate at a clinic substantially improves clinical outcomes at reduced annual cost levels.

Adolescent↗
PubMed2003

[Comparison between automatic and manual analysis in the diagnosis of obstructive sleep apnea-hypopnea syndrome].

OBJECTIVE: To compare automatic and manual analysis of neurological and respiratory variables obtained with the SomnoStar alpha 4100, a 16-channel polysomnographic system. PATIENTS AND METHOD: Twenty-eight patients suspected of obstructive sleep apnea-hypopnea syndrome were enrolled and given conventional polysomnographic tests. The order of automatic and manual reading of respiratory episodes, sleep stages, and arousals was randomized. We assessed agreement with the intraclass correlation coefficient and plotted standardized differences against standardized means, using the Bland-Altman method. RESULTS: Poor agreement was observed between the 2 types of analysis of sleep stages, especially for REM and deep sleep stages. Agreement was good for apneic episodes among the respiratory variables; however, automatic analysis underestimated hypopneas. If manual analysis is considered the gold standard at the apnea-hypopnea index cut point greater than 10, automatic analysis obtained a sensitivity of 55%, a specificity and positive predictive value of 100%, a negative predictive value of 47%, and an overall diagnostic yield of 67.8%. CONCLUSIONS: The automatic analysis of the SomnoStar 4100 system provides an unsatisfactory reading of sleep stages and respiratory episodes, especially hypopneas.

Female↗
PubMed2003

Depression in Parkinson's disease: clinical correlates and outcome.

Depression has been shown to be more common in Parkinson's disease (PD) than in other chronic and disabling disorders. Neurochemical and functional disturbances are important etiopathogenic factors. The prevalence and clinical features associated with depression in PD remain controversial. The purpose of this study is to estimate the prevalence of depressive symptoms in our patients, as related to other clinical data, and to assess clinical outcomes of these symptoms. A series of PD patients were evaluated over a 9-year period, using the Unified Parkinson's Disease Rating Scale (UPDRS), Hoehn and Yahr stage (HY), Schwab and England Scale (SE), Mini-Mental State Examination (MMSE), and Yesavage Geriatric Depression Scale (GDS). Presence of depressive symptoms was considered if GDS score was higher than 10: mild-moderate (MD) for GDS scores between 11 and 20 and moderate-severe (SD) for GDS scores greater than 20. Three hundred and fifty-three patients were included in this study and additional follow up information was obtained for 184 patients. MD and SD were found in 40.2 and 16.7% of PD patients, respectively. Female gender, high HY, high UPDRS total and subtotal, and low MMSE and SE scores were significantly associated with depressive symptoms. According to changes in GDS score, 34% of patients remained stable, 35% showed an improvement, and 30.9% worsened in the follow up study. Gender, age, age of onset, HY, UPDRS, and PD duration are not related to depression outcome.

Aged↗
PubMed2002

[Intracranial purulent collections. Review of 34 surgically treated cases in 12 years (1989-2000)].

We made a revision of 34 cases of intracerebral supurations (31 brain abscesses and 3 subdural empyemas) treated at our department of neurosurgery of "Mutua de Terrassa" during the period of 1989-2000. Treatment used was tapping of the abscess and aspiration in 28 cases and craneotomy and resection in only two cases. Three subdural empyemas were treated with burr-holes and aspiration. Results were evaluated using the Glasgow Outcome Scale at 6 months after discharge, resulting in 7 deaths (20.6%), 17 fully recovered patients (50%) and 10 with minor deficits (29.4%). Glasgow Coma Score at admission and the age were the unique variables significantly correlated with the final outcome. After analyzing the cost of treatment in our patients we suggest using antibiotic ambulatory treatment when the disease shows an adequate clinical and radiological response, thus permitting to shorten the usually long period of hospitalization of patients with intracerebral supurative diseases.

Adolescent↗
PubMed2002

The importance of educational and psychological factors in Parkinson's disease quality of life.

OBJECTIVE: To define the factors correlated with quality of life (QoL) in patients with idiopathic Parkinson's disease (PD). BACKGROUND: PD has a substantial impact on QoL. Although several clinical factors have been associated with QoL in PD, the influence of patient's education still remains controversial. METHODOLOGY: A consecutive series of patients with PD were examined using the unified Parkinson's Disease Rating Scale (UPDRS part I, II, III), Schwab and England (SE), and Hoehn and Yahr stage (H&Y). QoL was rated with the PDQ-39, cognition with the Mini-Mental State examination (MMSE), and the presence of depressive symptoms with the geriatric depression scale (GDS). Patient's characteristics, estimated cumulative levodopa dose (CLD), UPDRS, H&Y, MMSE and GDS were correlated with the PDQ-39 using univariate and multiple regression analysis. RESULTS: A total of one hundred 58 patients (68 men, 90 women) with a mean age of 65.6 +/- 9.3 years, PD duration of 8.1 +/- 10.6 years, and education of 6.6 +/- 3.9 years were included. The mean PDQ-39 was 48.8 +/- 27.8, mean MMSE was 25.7 +/- 4, and mean GDS was 11.7 +/- 6.8. Using stepwise multiple regression analysis, the most important predictive factors were depression, UPDRS part I, UPDRS part II, and educational background, which accounted for a 61% of the variability of the PDQ-39 scores. CONCLUSIONS: In our PD sample, educational, behavioural, and psychological factors influenced life satisfaction more than physical ones.

Aged↗
PubMed2001

The bronchodilator test with increasing doses of terbutaline in chronic obstructive pulmonary disease patients.

There is no uniform consensus on the dose of bronchodilator to be used in the bronchodilator test (BDT). The objective of the study was to determine the dose of inhaled terbutaline that can safely achieve a greater number of positive BDT in patients with chronic obstructive pulmonary disease (COPD). The study was prospective and single blinded. One-hundred and fifty patients with stable COPD were included. Their mean (+/-SD) age was 67.4 (8.8) years. Their mean forced expiratory volume in the first second (FEV1) was 1.14 (0.48) l (41% of the predicted value). A baseline spirometry was performed and a second 20 min after the inhalation of placebo. Three consecutive doses of 500 microg of inhaled terbutaline were administered and a new spirometry was performed after each one. A multivariate analysis based on the comparison of the repeated means was performed in order to analyse the spirometric changes achieved after the different doses of bronchodilator. The increase of FEV1 and forced vital capacity (FVC) with the two first doses of terbutaline was statistically significant; the increase of the peak expiratory flow (PEF) was significant after the three doses administered. The number of positive BDT were 40, 47 and 60 after each dose of terbutaline (P=0.004). The higher dose of terbutaline was more useful in identifying patients with significant bronchoreversibility and, moreover, was well tolerated. We suggest that this dose (1500 microg) should be routinely used in performing the BDT.

Aged↗
PubMed2001

Treatment of rheumatoid arthritis by oral administration of bovine tracheal type II collagen.

We evaluated the efficacy and safety of orally administered bovine tracheal type II collagen (CGII) in the treatment of rheumatoid arthritis (RA). Twenty RA patients received 0.5 mg/day of CGII for 12 weeks. Eighteen of them had improvements in the clinical parameters studied (swollen and tender joint counts, 15-m walking time, duration of morning stiffness, and physician's global assessment of disease activity). Anti-CGII antibodies were positive in 57% and rheumatoid factor (RF) in 71% of the patients with a short history of RA ( < or =2 years), whereas only 23% of those with long histories (>2 years) presented autoantibodies to CGII and 38% had positive RF. After the treatment, four patients showed reduced RF levels and all those with detectable serum tumor necrosis factor alpha (TNF-alpha) experienced its return to normal or levels below those at study entry. Although a placebo effect cannot be discounted, the oral administration of bovine tracheal CGII induced clinical benefits in 90% of the patients, without the side effects usually associated with treatment. This is the first study showing that feeding CGII can induce reductions in RF and TNF-alpha. The data justify further controlled studies to assess the long-term efficacy of this treatment approach.

Administration, Oral↗
PubMed2001

Daily assessment of severity of illness and mortality prediction for individual patients.

OBJECTIVE: To refine the prognosis of critically ill patients using a statistical model that incorporates the daily probabilities of hospital mortality during the first week of stay in the intensive care unit (ICU). DESIGN: Prospective inception cohort. SETTING: Fifteen adult medical and surgical ICUs in Spain. PATIENTS: A total of 1,441 patients aged > or =18 yrs who were consecutively admitted from April 1, 1995, through July 31, 1995. INTERVENTIONS: Prospective data collection during the stay of the patient in the ICU. Data collected included vital status at hospital discharge as well as all variables necessary for computing the Mortality Probability Models II system at admission and during the first 7 days of stay in the ICU. MEASUREMENTS AND MAIN RESULTS: Four logistic regression models were obtained. These models contained survival status at hospital discharge as a dependent variable and the following explanatory variables: (model 1) only the probability of dying at admission; (model 2) only the probability of dying during the current day; (model 3) the probability of dying at admission and during the current day; and (model 4) the probabilities of dying at admission and during the previous and current days. Models were evaluated using the Hosmer-Lemeshow statistic and the area under the receiver operating characteristic curve. For survivor and nonsurvivor patients, mortality probabilities obtained using the aforementioned models were compared using linear regression and the paired Student's t-test. Although severity at admission was a statistically significant variable, models 2 and 3 produced almost the same probabilities of hospital mortality, as shown with the linear regression and paired Student's t-test results. CONCLUSIONS: To have an accurate measurement of the prognosis, it is necessary to update the severity measure. The best estimate of hospital mortality was the probability of death on the current day. Severity at admission and at previous days did not improve the assessment of prognosis.

Adult↗
PubMed2000

Interobserver variability of the measurement of the mortality probability models (MPM II) in the assessment of severity of illness.

OBJECTIVE: To assess the interobserver variability of the measurement of the MPM II system. DESIGN: Random sample of an inception cohort. SETTING: Fifteen adult medical and surgical intensive care units (ICUs) in Spain. PATIENTS: A 5% random sample (n = 119) of 2332 patients consecutively admitted in the ICU, aged 18 years or older. INTERVENTIONS: Prospective data collection during the stay of the patient in the ICU. Repeated data collection, after the patient's hospital discharge. MEASUREMENTS AND MAIN RESULTS: Demographic information, length-of-stay and vital status at both ICU and hospital discharge, as well as all variables necessary for computing the MPM II system were measured. Interobserver variability for categorical variables was measured computing the kappa index. For interval variables the interobserver variability was assessed by the intraclass correlation coefficient, the paired t-test, and linear regression. In the MPM II0 index, the variables coma, heart rate, systolic blood pressure, chronic renal insufficiency, metastatic neoplasm, acute renal failure, cardiac dysrhythmia and cardiopulmonary resuscitation, showed moderate or low levels of agreement. In the MPM II24 index, the variables coma or deep stupor, PaO2 and prothrombin time showed low or moderate interobserver agreement. Agreement for the MPM II probability of death was high, although the external observer obtained a lower estimation than the hospital observer. CONCLUSIONS: The MPM II severity system showed a high level of stability when used in groups of patients. Nevertheless, the observed variability in some variables means that it should be used with caution for individual patients.

Adult↗
PubMed2000

Performance of the Mortality Probability Models in assessing severity of illness during the first week in the intensive care unit.

OBJECTIVE: To extend the Mortality Probability Models (MPM) II severity system to time periods between 4 and 7 days after admission to the intensive care unit (ICU). DESIGN: Prospective inception cohort. SETTING: Fifteen adult medical and surgical ICUs in Spain. PATIENTS: A total of 1,441 patients aged > or =18 yrs consecutively admitted from April 1, 1995 through July 31, 1995. INTERVENTIONS: Prospective data collection during the stay of the patient in the ICU. Data collected included demographic information, length-of-stay and vital status at both ICU and hospital discharge, as well as all variables necessary for computing the MPM II system at admission and during the first 7 days of stay in the ICU MEASUREMENTS AND MAIN RESULTS: Calibration and discrimination of the four existing MPM II models (MPM0, MPM24, MPM48, and MPM72) were assessed in the study database. The MPM II system overestimated the mortality of patients with probabilities of death > or =0.4. The MPM24 model was customized. Models for time periods between 48 hrs and 7 days (MPM48 to MPMd7) were obtained using the same strategy that was used to develop the original MPM48 and the MPM72 models. The variable coefficients of the MPM24 model were kept fixed and the constant terms of the MPM48 to MPMd7 models were estimated by logistic regression. The constant term stabilized after the fourth day of admission and it was similar to the constant term of the MPM72 model. The customized MPM72 performed very well for days 4 to 7 after admission to the ICU. CONCLUSIONS: If the patient's condition stays the same day after day, the probability of dying in the hospital increases until 72 hrs, and then stabilizes. A severity measure that performs well at 72 hrs can be a useful tool for measuring severity at later time periods.

Critical Care↗