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Biomedical subjects

S Quintana

Publications and source records attributed to S Quintana.

31 records · Page 2Linked to original sources
PubMed2000

Accuracy of an enzyme immunoassay for the detection of Helicobacter pylori in stool specimens in the diagnosis of infection and posttreatment check-up.

OBJECTIVE: The aim of this study was to assess the reliability of a newly developed enzyme immunoassay for Helicobacter pylori-specific antigen detection in stools (HpSA) compared to other standardized diagnostic techniques such as histology (H), rapid urease test (RUT) and 13C-urea breath test (UBT) to diagnose H. pylori infection and to evaluate its usefulness in determining H. pylori status after treatment. METHODS: One hundred eighty-eight patients referred to our department for upper gastrointestinal endoscopy were included. H. pylori infection was confirmed in all patients by HpSA test in stools, RUT, UBT, and H. Patients were defined as positive for H. pylori if RUT and UBT or H were positive. A total of 142 symptomatic patients received eradication treatment and were reassessed 6 wk after therapy; for 70 of these patients, stool samples were also collected at 24 h and 6 months after finishing eradication treatment. In the posttreatment follow-up, UBT was used as gold standard. RESULTS: The sensitivity of HpSA test for the diagnosis of H. pylori infection using a cut-off value of 0.130 was 89.5% and its specificity 77.8%. This specificity was lower than that obtained with UBT, H, and RUT. In the early follow-up the sensitivity of HpSA test was null. At 6 weeks and at 6 months post-treatment its sensitivity was 70.4% and 50% and its specificity was 81.6% and 79.3%, respectively. CONCLUSIONS: The HpSA stool test, using a cut-off value of 0.130, may be useful for the primary diagnosis of H. pylori infection, with sensitivity similar to that obtained with other standard tests, but with less specificity. HpSA test is not useful for early monitoring of treatment efficacy. At 6 wk and at 6 months posttreatment, HpSA test lacks accuracy as compared to UBT for evaluating the outcome of the eradication treatment.

Anti-Bacterial Agents↗
PubMed1999

Contribution of ipratropium bromide to the bronchodilator test in patients with chronic obstructive pulmonary disease.

The aim of the study was to analyze the bronchodilator test (BDT) response to ipratropium bromide (IB) in patients with chronic obstructive pulmonary disease (COPD) who do not respond to inhaled terbutaline. Sixty patients with stable COPD who showed a negative response to BDT, defined as an increase of less than 160 ml in the forced expiratory volume in the first second (FEV1) after inhaling 1500 microg of terbutaline, were recruited. Each patients randomly received 200 microg of IB or placebo in a single blinded fashion, and a spirometric study was made at 30 and 60 min. The increase in absolute values of FEV1 at 30 and 60 min after IB was significantly higher than after placebo. The means +/- SD were 126 +/- 93 vs. 70 +/- 96 ml at 30 min and 148 +/- 120 vs. 74 +/- 132 ml at 60 min (P=0.01). The BDT was positive in 57% of patients who received IB, considering a positive response as an increase of FEV1 greater than 160 ml (P=0.01). We conclude that the BDT was positive with high doses of IB in more than half of COPD patients who did not respond to terbutaline alone.

Aged↗
PubMed1998

Mortality prediction in head trauma patients: performance of Glasgow Coma Score and general severity systems.

OBJECTIVE: To assess the performance of general severity systems (Acute Physiology and Chronic Health Evaluation [APACHE] II, Simplified Acute Physiology Score [SAPS] II, and Mortality Probability Models [MPM] II) for head trauma patients and to compare these systems with the Glasgow Coma Score, in order to obtain a good estimate of severity of illness and probability of hospital mortality. DESIGN: Inception cohort. SETTING: Adult medical and surgical intensive care units in 12 European and North American countries. PATIENTS: Patients (n = 401) who were diagnosed with head trauma (with/without multiple trauma), leading to intensive care unit admission, and who were not brain dead at the time of arrival. INTERVENTIONS: Statistical analysis to assess the performance of general severity systems. MEASUREMENTS AND MAIN RESULTS: Vital status at the time of hospital discharge was the outcome measure. Performance of the severity systems (SAPS II, MPM II0 [MPM at admission], MPM II24 [MPM at 24 hrs], and APACHE II) was assessed by evaluating calibration and discrimination. Logistic regression was used to convert the Glasgow Coma Score into a probability of death. The MPM II system (either MPM II0 or MPM 1124) provided an adequate estimation of the mortality experience in patients with head trauma. SAPS II and APACHE II systems did not calibrate well, although they showed high discrimination (area under the receiver operating characteristic curve 0.95 for SAPS II, 0.94 for APACHE II, and 0.90 for MPM II0 and MPM II24). The logistic regression model containing the Glasgow Coma Score as an independent variable and developed in this group of patients was not as well calibrated as MPM II. The discrimination of this model was very high, in the range observed for the APACHE II, SAPS II, and MPM II systems. CONCLUSIONS: The MPM II system performs better than APACHE II, SAPS II, and Glasgow Coma Score for head trauma patients. If our results are supported by other studies, MPM II would be an appropriate tool to assess severity of illness in head trauma patients, with applications to clinical practice and clinical research.

APACHE↗
PubMed1998

Randomized clinical trial comparing two one-week triple-therapy regimens for the eradication of Helicobacter pylori infection and duodenal ulcer healing.

OBJECTIVE: One-week triple therapy has been shown to be effective in Helicobacter pylori eradication and duodenal ulcer healing. However, the optimal therapeutic combination has not yet been identified. Bismuth-containing regimens have the advantage of requiring only one antibiotic. It has been suggested that high doses of omeprazole improve the bactericidal efficacy of antimicrobial regimens against H. pylori. We evaluated the efficacy of two 1-wk triple-therapy regimens for H. pylori eradication and duodenal ulcer healing. METHODS: On an intention-to-treat basis, 182 patients with H. pylori-associated duodenal ulcer were randomized. Group OCB patients (n = 91) were given omeprazole 40 mg b.i.d., clarithromycin 500 mg b.i.d., and colloidal bismuth subcitrate 120 mg q.i.d. for 7 days. Group OCA patients (n = 91) were treated with omeprazole and clarithromycin at the same doses plus amoxicillin 1 g b.i.d., also for 7 days. Endoscopies were performed at entry and at 4 wk after the end of treatment. The presence of H. pylori was assessed by urease test, histology, Gram stain, and culture. No patient received follow-up treatment. RESULTS: H. pylori eradication rates achieved in the OCB and OCA groups were similar whether by intention-to-treat (82.4% vs 88.9% ;p = 0.21) or per protocol analysis (83.3% vs 89.9%; p = 0.19). Duodenal ulcer healing rates also were the same for OCB and OCA in intention-to treat (91.2% vs 91.1%) and per protocol analysis (92.2% vs 92.1%), respectively (p = 0.98). CONCLUSIONS: High rates of H. pylori eradication and duodenal ulcer healing were obtained with both short-treatment regimens, which were safe and well-tolerated. Colloidal bismuth subcitrate seems to be a good alternative to amoxicillin in the triple-therapy combination with omeprazole and clarithromycin. The omeprazole dose does not seem to play a major role in H. pylori eradication in these therapeutic combinations.

Adult↗
PubMed1996

[Antiaggregant treatment for cerebral ischemia: ticlopidine versus aspirin].

INTRODUCTION: There at present exists marked controversy as to the possible greater efficacy of ticlopidine as opposed to aspirin in brain ischaemia secondary prophylaxis. In our study we compare the efficacy and safety of antiaggregant treatment with ticlopidine as opposed to aspirin in a group of 310 patients admitted to the 'Hospital Mutua de Terrassa' between the years 1990 and 1994. RESULTS: In the group of patients treated with ticlopidine we found a larger number of new cerebrovascular incidents (p = 0.02) and peripheral vascular incidents (p = 0.01). New cerebrovascular incidents were more frequent in males (p = 0.03), in those patients with substantiated infarct (p = 0.02) and in patients with ischaemia in the carotidal region (p = 0.04). On the other hand, the group of patients treated with ticlopidine presented more secondary effects than the group treated with aspirin at the digestive (p < 0.001) and haematologic (p < 0.001) levels. The most frequent digestive secondary effects were diarrhoea (p < 0.001) and hepatopathy (p = 0.02); abnormalities in the leucocyte count were more frequent in patients treated with ticlopidine (p < 0.001), neutropenia being found in 0.8% of cases. CONCLUSION: In the patients we studied ticlopidine was less efficacious than aspirin in the secondary prophylaxis of new vascular incidents (both cerebrovascular and peripheral vascular) and also presented a greater incidence of secondary (digestive and haematological) effects.

Aged↗
PubMed1995

[The perception of improvement in asthma].

BACKGROUND: The capacity of stable asthma patients to recognize the presence of air flow obstruction, treatment improvement and daily variations was studied. METHODS: Placebo and 500 micrograms of inhaled terbutaline for two consecutive days were administered to 39 patients. The subjective impressions were compared with spirometric results. RESULTS: Thirty patients presented obstruction of which 7 reported to be asymptomatic and 9 presented normal spirometry of which 3 reported to be symptomatic. Fifty-four percent (21) did not correctly recognize whether they improved with the medication either of the two days. Eleven patients reported improvement with placebo without significant spirometric changes. Eighteen preferred terbutaline and 5 the placebo while 16 were indifferent out of whom 7 (43%) had improved with only the bronchodilator. The FEV1 difference between the two days was > 10% in 18 patients of which this was not perceived in 10. CONCLUSIONS: Objective controls are necessary for the evaluation and follow up of patients with stable asthma.

Adolescent↗
PubMed1995

Treatment of cerebral Aspergillosis with itraconazole: do high doses improve the prognosis?

We describe a 72-year-old woman with chronic asthma who presented with cerebral abscesses due to Aspergillus fumigatus after she received treatment with corticosteroids. Therapy with high-dose itraconazole (800 mg/d for 5 months, followed by 400 mg/d for an additional 4.5 months) resulted in complete resolution of all lesions. Serum concentrations of the drug ranged from 2 micrograms/mL to 30 micrograms/mL. Review of 20 cases of cerebral aspergillosis that were treated with itraconazole revealed that three of the four patients who received high doses (800 mg/d in the adults) of the drug responded favorably, while only two of the 16 patients who received a dose of 400 mg/d were cured. The use of high-dose itraconazole appears to be justified for high-risk patients with cerebral aspergillosis for whom conventional therapy has failed.

Aged↗
PubMed1994

[Percutaneous endoscopic gastrostomy: study on 35 patients].

BACKGROUND: A review of the technique, indications, complications and follow up of percutaneous endoscopic gastrostomy (PEG) was performed. METHODS: Thirty-five patients in whom a PEG had been placed according to the Ponsky technique from 1991 to 1993 were analyzed 27 of whom had neurologic disease, 6 tumoral diseases and 2 other causes. RESULTS: PEG was carried out in 33 patients with no incidences while the technique could not be performed in 2 since the point could not be identified by transillumination in the gastric wall. No immediate complications were observed. Seven minor early complications were presented as wound infection with the cannula being withdrawn in only one case due to persistence of the infection. Five late complications were reported: 1 severe (gastrocholic fistula) and 4 minor (2 cannula obstructions, 1 displacement and 1 infection). Evolution was followed in 31 patients with the cannula being withdrawn in 4 (2 because of complications and in the other 2 on initiation of oral diet). The cannula was substituted at 120 and 360 days in 2 patients. Sixteen patients died, 5 during the first 30 days due to the primary disease, with only one case (aspirative pneumonia) being related to the PEG. The PEG continues functioning in 11 patients. CONCLUSIONS: Percutaneous endoscopic gastrostomy for feeding is a simple technique which may be carried out in most patients with scarce severe complications, allowing a good nutritional state and improving the quality of life of patients requiring prolonged enteral feeding.

Adult↗
PubMed1993

Progesterone challenge test for the assessment of endometrial pathology in asymptomatic menopausal women.

The progesterone challenge test was correlated with endometrial pathology in 130 asymptomatic menopausal women without hormonal treatment. The sensitivity of the test for detection of endometrial proliferative activity was 76%, specificity 100%, positive predictive value 100% and negative predictive value 94.1%. A 10-day test provided better results than a 5-day test. The test seems useful for detection of those at high risk for endometrial cancer.

Biopsy↗
PubMedDate not supplied

[Study of associated clinical variables and phenomenology of hallucinations in Parkinson's].

INTRODUCTION: Although hallucinations are considered to be a dopaminergic related phenomenon, the correlation between hallucinations with other features in Parkinson's disease (PD) still remains controversial. OBJECTIVES: To define the phenomenology and factors that contribute to hallucinations in patients with idiopathic PD, and to determine their correlation with the Parkinsonian motor state (on versus off ). METHOD: A consecutive series of patients with PD were examined using the motor subscale of the Unified Parkinson's Disease Rating Scale (UPDRSm), Hoehn and Yahr stage (HY), Mini-Mental State Examination (MMSE) and a questionnaire on hallucinations, motor state and sleep disorders. Patient's characteristics, treatment, motor status, and sleep disorders were correlated with the presence of hallucinations using parametric and non-parametric tests. RESULTS: Thirty eight patients (18 men, 20 women) with a mean age of 73.3 +/- 7 years, PD duration of 9 +/- 7 years, median HY stage of 2 (2-5), and a MMSE of 25 +/- 4 were included. Compared to non hallucinators (15 patients), hallucinators (23 patients) had a higher HY (p = 0.01), UPDRSm (p = 0.004), PD duration (p = 0.01), PD treatment duration (p = 0.03), presence of sleep disorders (p = 0.05) and were taking higher total daily doses of levodopa (p = 0.05). A multivariate analysis found that higher UPDRSm scores and total levodopa daily dose were the main clinical variables associated with hallucinations. Age, gender, MMSE scores, prior levodopa dose or dopaminergic agonists, and motor state did not influence the presence of hallucinations. CONCLUSIONS: In this study, hallucinations were not correlated with the Parkinsonian motor state. Although motor severity impairment and total levodopa daily dose were the main clinical variables associated with hallucinations, other clinical factors such as sleep disorders and treatment duration should be considered.

Aged↗