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Biomedical subjects

T Rodriguez

Publications and source records attributed to T Rodriguez.

At least 19 recordsLinked to original sources
PubMed2006

Autologous hematopoietic stem cell transplants that utilize total body irradiation can safely be carried out entirely on an outpatient basis.

Outpatient hematopoietic stem cell transplants (HSCT) are usually performed in patients receiving minimally mucotoxic preparative regimens; total body irradiation (TBI)-based regimens typically are excluded. To improve resource utilization and patient satisfaction, we developed a totally outpatient HSCT program for TBI regimens and compared outcomes for our first 100 such transplants to 32 performed as in-patients during the same interval, for caregiver or financial reasons. Symptoms were managed predominately with oral agents; pain management consisted of transdermal fentanyl and oral morphine solution. Except for more unmarried in-patients, the two groups were matched. Time to engraftment, severity of mucositis and transplant duration were identical for the two groups. Twenty-seven of the outpatients were admitted (median-6 days), primarily for progressing infection. Thus 92% of all transplant days were outpatient. There were no septic episodes or hospital admissions for pain management. There were no deaths to day 30 in either group and 100-day survival was identical. There was a mean cost savings of Dollars 16,000 per outpatient transplant and outpatient patient/caregiver quality of life was similar to that reported for in-patients. Patients undergoing severely mucotoxic regimens can be safely transplanted in an outpatient setting with a significant cost saving, with no increase in morbidity or mortality.

Adult↗
PubMed2006

Patients' understanding of disease status and treatment plan at initial hematopoietic stem cell transplantation consultation.

Patients referred for hematopoietic stem cell transplantation (HSCT) often have knowledge deficits about their disease and overestimate their prognosis making it difficult initially to discuss potentially life-threatening transplant options. To determine patients' understanding of their disease and the adequacy of a 3-h consultation at our center, we developed a survey that measured perceived knowledge deficits of disease, prognosis, and emotional status before and after their initial consultation. Ninety nine consecutive eligible patients completed the survey. Although 76.7% claimed adequate information about their disease pre-HCST visit, 51.5 and 41.4% respectively lacked knowledge about their 1-year prognosis with and without any therapy. After the visit, 66.7% of the patients had obtained enough information to make an informed decision regarding HSCT versus 23.2% pre-visit, and a significant reduction in the need for further information was reported by 53.5% of patients (P<0.001). Patients were not overwhelmed or confused by the visit and there was a small but significant decrease in negative affect. Measures to increase patients understanding of their disease and its prognosis pre-HSCT consultation visit are warranted; however, a 3-h consultation visit provides the majority of patients with sufficient information to make an informed decision about the risk/benefit ratio of HSCT.

Data Collection↗
PubMed2005

Second allografts for relapsed hematologic malignancies: feasibility of using a different donor.

A second allogeneic hematopoietic stem cell transplant (HSCT) for relapsed hematologic malignancies is an option in select patients after an initial allograft has failed. If the original donor is not available, a different donor may have to be considered. We report our experience of performing a second allogeneic HSCT using a different donor in patients with relapsed leukemia and lymphoma. In a 5-year period, six patients underwent a second allograft with myeloablative conditioning using a different donor. Four of these were retransplanted using a matched-unrelated donor. Four of the patients (67%) remain progression-free at a median follow-up of 32 months (range 3-72). There were no cases of transplant-related mortality. We conclude that a second allogeneic HSCT using a different donor is a viable option for selected patients relapsing after an allograft if the original donor is not available.

Adolescent↗
PubMed2003

Hypothyroidism attenuates stress-induced prolactin and corticosterone release in septic rats.

We investigated the effects of sepsis, through the lipopolysaccharide (LPS)-induced inflammatory response, on plasma corticosterone and prolactin (PRL) levels during acute immobilization stress in normal and thyroidectomized rats. Thyroidectomized (TX) or sham-operated (N) rats were subjected to 120 min of immobilization stress. Rats were treated with an intraperitoneal injection of either LPS (250 microg (100 g body wt)(-1)) or the same volume of vehicle (saline solution), 90 min before the induction of stress. Blood samples for hormone assays were collected before sepsis and stress induction for baseline measures (-90 min), and during sepsis and immobilization stress for the measurement of prolactin and corticosterone levels by radioimmunoassay. Our results show that the thyroid hormones are necessary for a proper response of PRL and corticosterone release during immobilization stress. Although sepsis enhanced PRL secretion, this was not true of corticosterone release in either group of rats. Low levels of thyroid hormones partially block the release of PRL, but do not block corticosterone secretion during sepsis.

Animals↗
PubMed2001

Bayes factor of model selection validates FLMP.

The fuzzy logical model of perception (FLMP; Massaro, 1998) has been extremely successful at describing performance across a wide range of ecological domains as well as for a broad spectrum of individuals. An important issue is whether this descriptive ability is theoretically informative or whether it simply reflects the model's ability to describe a wider range of possible outcomes. Previous tests and contrasts of this model with others have been adjudicated on the basis of both a root mean square deviation (RMSD) for goodness-of-fit and an observed RMSD relative to a benchmark RMSD if the model was indeed correct. We extend the model evaluation by another technique called Bayes factor (Kass & Raftery, 1995; Myung & Pitt, 1997). The FLMP maintains its significant descriptive advantage with this new criterion. In a series of simulations, the RMSD also accurately recovers the correct model under actual experimental conditions. When additional variability was added to the results, the models continued to be recoverable. In addition to its descriptive accuracy, RMSD should not be ignored in model testing because it can be justified theoretically and provides a direct and meaningful index of goodness-of-fit. We also make the case for the necessity of free parameters in model testing. Finally, using Newton's law of universal gravitation as an analogy, we argue that it might not be valid to expect a model's fit to be invariant across the whole range of possible parameter values for the model. We advocate that model selection should be analogous to perceptual judgment, which is characterized by the optimal use of multiple sources of information (e.g., the FLMP). Conclusions about models should be based on several selection criteria.

Bayes Theorem↗
PubMed2000

The challenge of evaluating fatigue.

Fatigue, though a common complaint, presents a challenge to nurse practitioners who must evaluate its significance in the primary care setting. Fatigue is described as a multidimensional phenomenon and is classified as physiologic, acute, or chronic. A distinction is made between chronic fatigue and chronic fatigue syndrome (CFS). The use of the Piper Fatigue Scale is suggested in order to objectively quantify this symptom in clinical practice. In this article, the Habit and Lifestyle Form for the Evaluation of Fatigue is presented as a way to assist the provider in considering simple and obvious causes of fatigue that may otherwise be overlooked. Finally, an algorithm for the evaluation of fatigue is presented.

Algorithms↗
PubMed2000

The homeobox gene Hex is required in definitive endodermal tissues for normal forebrain, liver and thyroid formation.

The homeobox gene Hex is expressed in the anterior visceral endoderm (AVE) and rostral definitive endoderm of early mouse embryos. Later, Hex transcripts are detected in liver, thyroid and endothelial precursor cells. A null mutation was introduced into the Hex locus by homologous recombination in embryonic stem cells. Hex mutant embryos exhibit varying degrees of anterior truncation as well as liver and thyroid dysplasia. The liver diverticulum is formed but migration of hepatocytes into the septum transversum fails to occur. Development of the thyroid is arrested at the thyroid bud stage at 9.5 dpc. Brain defects are restricted to the rostral forebrain and have a caudal limit at the zona limitans intrathalamica, the boundary between dorsal and ventral thalamus. Analysis of Hex(-/-) mutants at early stages shows that the prospective forebrain ectoderm is correctly induced and patterned at 7.5 days post coitum (dpc), but subsequently fails to develop. AVE markers are expressed and correctly positioned but development of rostral definitive endoderm is greatly disturbed in Hex(-/-) embryos. Chimeric embryos composed of Hex(-/-) cells developing within a wild-type visceral endoderm show forebrain defects indicating that Hex is required in the definitive endoderm. All together, these results demonstrate that Hex function is essential in definitive endoderm for normal development of the forebrain, liver and thyroid gland.

Animals↗
PubMed1999

Alcohol and stroke: a community case-control study in Asturias, Spain.

The relationship between alcohol consumption and stroke is uncertain. Heavy alcohol consumption has been associated with an increased risk of stroke, while light drinking appears to be protective. However, the evidence is not uniform. We sought to examine the relationship between alcohol consumption and stroke, according to stroke type. We performed a population-based case-control study from September 1990 to December 1991. The study comprised 467 incident cases of stroke and 477 controls aged between 40 and 85. Case was defined following WHO criteria and control was randomly selected from the study base population. Alcohol exposure was obtained by medical interview. We found that consumption of less than 30 g/day of alcohol was protective against all stroke types combined, the multivariated adjusted odds ratio (OR) was 0.58 (95% confidence interval [CI], 0.41-0.83). Moderate alcohol drinking is also protective against all cerebral infarction combined (OR = 0.53; 95% CI, 0.35-0.80) and cortical infarction (OR = 0.40; 95% CI, 0.18-0.86). Drinking up to 30 g/day of alcohol has a borderline protective effect on deep cerebral infarction (OR = 0.40; 95% CI, 0.16-1.02) and has no effect on intracerebral hemorrhage (OR = 0.88; 95% CI, 0.44-1.74). Heavy alcohol drinking, over 140 g/day, is a risk factor for all stroke types combined (OR = 3.2; 95% CI, 1.1-9.7), all cerebral infarction combined (OR = 5.0; 95% CI, 1.5-16.3), small deep cerebral infarction (OR = 9.7; 95% CI, 2.6-36.7), intracerebral hemorrhage (OR = 6.2; 95% CI, 1.3-24.0), and is marginally associated with superficial cerebral infarction (OR = 4.6; 95% CI, 1.0-20.6). The relationship between alcohol and stroke depends on the alcohol dose and the pathology of the disease. Atherosclerosis of the large and medium cerebral arteries is found mainly in superficial cerebral infarction, and this type of stroke shows a J-shaped relationship with alcohol similar to that found in coronary heart disease, suggesting that they are similar diseases. On the other hand, arteriosclerosis of the penetrating arteries has been found in deep cerebral infarction and intracerebral hemorrhage, while atherosclerosis is not prominent. This may explain why alcohol does not have a protective effect on cerebral hemorrhage whereas heavy drinking is a strong risk factor in these two types of stroke.

Adult↗
PubMed1999

Trehalose hydrolysis is not required for human serum-induced dimorphic transition in Candida albicans: evidence from a tps1/tps1 mutant deficient in trehalose synthesis.

Exponential yeast-like cells of a Candida albicans wild-type strain exhibited strong capacity for germ tube formation in a glucose-containing medium (YPD) after induction with human serum at 37 degrees C, whereas the isogenic double disruptant tps1/tps1 mutant, which is deficient in trehalose synthesis, failed to produce germ tubes. In a medium without glucose (YP), the morphological transition fraction was roughly equivalent in both strains. Substitution of glucose by galactose or glycerol increased the number of wild-type proliferating cells able to enter the dimorphic program with no noticeable change in their trehalose content, while stationary cells, which accumulate a large amount of trehalose, did not form germ tubes. When fresh medium was added, a high proportion of these resting cells recovered their ability to carry out dimorphic transition. The tps1/tps1 mutant followed the same pattern of hyphae formation, despite the fact that it was unable to accumulate trehalose either during dimorphism induction or after several stress challenges. Furthermore, trehalose-6-phosphate synthase activity was barely detectable in the mutant. These results strongly suggest that serum-induced dimorphic transition does not require trehalose mobilization; they also support the idea that TPS1 is the only activity involved in trehalose biosynthesis in C. albicans.

Blood Proteins↗
PubMed1999

Family history and stroke: a community case-control study in Asturias, Spain.

BACKGROUND: Family history of stroke has been considered as a risk factor for stroke, but this relationship is controversial. Some, but not all, studies have found an independent association between family history of stroke and stroke. This study examines the relationship between family history of stroke and all stroke types combined, cerebral infarction and intraparenchymatous haemorrhage. METHODS: This is an incidence type, population-based case-control study. Cases were defined following WHO criteria and controls were randomly selected from the study-base population. Family history of stroke was obtained by medical interview. A total of 470 cases and 477 controls, aged 40-85 years, form the subjects of the study. RESULTS: Family history of stroke in a first-degree relative is an independent risk factor for all stroke types combined, multivariate adjusted odds ratio (OR) 1.74, 95% confidence interval (CI) 1.24-2.44, for cerebral infarction, OR = 1.79 (95% CI 1.25-2.56), but not for intraparenchymatous haemorrhage, OR = 1.71 (95% CI 0.91-3.17). Risk of all stroke types combined was independently associated with a positive history of father with stroke OR = 1.93 (1.19-3.54) with a positive history of sibling with stroke, OR = 1.67 (95% CI 1.03-2.71) and a borderline significant association with a positive history of mother with stroke OR = 1.45 (95% CI 0.92-2.29). Cerebral infarction was independently associated with a positive history of father with stroke OR = 2.05 (95% CI 1.17-3.59), a positive history of sibling, OR = 1.69 (95% CI 1.01-2.84) and a borderline significant association with a positive history of mother with stroke OR = 1.58 (95% CI 0.97-2.56). Intracerebral haemorrhage was not significantly associated with a positive history of father with stroke OR = 1.39 (0.55-3.58) with a positive history of sibling, OR = 1.83 (95% CI 0.77-4.40), or with a positive history of mother with stroke OR = 1.36 (95% CI 0.59-3.09). CONCLUSIONS: Family history of stroke is found in this study to be an independent risk factor for all stroke types combined and for cerebral infarction. Genetic factors may be involved, but it cannot be ruled out that the observed relationship is confounded by other risk factors, especially family aggregation of life-styles.

Adult↗
PubMed1998

X-linked subcortical laminar heterotopia and lissencephaly: a new family.

Magnetic resonance imaging (MRI) has enabled the identification of neuronal migration disorders in living subjects. This represents an important achievement in the diagnosis of patients with these anomalies. At least five affected families with coexistent subcortical laminar heterotopia and lissencephaly have been reported recently. This association suggests an X-linked pattern of inheritance. In the family that we report, the mother suffered from epilepsy and the oldest daughter from epilepsy and mental retardation. Both patients showed subcortical laminar heterotopia on MRI. The youngest son presented a severe encephalopathy with early onset seizures, and was found to show lissencephaly on MRI. The other two siblings, a boy and a girl, had no neurological abnormalities. The severity of these patients' clinical symptoms were clearly related to MRI findings.

Adolescent↗
PubMed1997

Prevalence of hepatitis A antibodies in southeastern Spain: a population-based study.

The prevalence of hepatitis A antibodies in the adult population of the Murcia Region (southeast of Spain) was estimated using an anonymous unlinked serosurvey in a population-based sample of 2,203 adults. The overall anti-HAV prevalence was 76.5%. The prevalence increased with age and was higher in individuals living in towns with less than 10,000 inhabitants.

Adolescent↗
PubMed1996

Association of autoantibodies against platelet glycoproteins Ib/IX and IIb/IIIa, and platelet-reactive anti-HIV antibodies in thrombocytopenic narcotic addicts.

The levels of platelet-associated Igs (PAIgs) and plasma circulating antiplatelet antibodies were evaluated by a flow cytometric immunofluorescence assay (FCIFA), an enzyme-linked immunoassay (ELISA), and a platelet radioactive antiglobulin test (PRAT), in a group of 45 human immunodeficiency virus (HIV)-infected intravenous drug users (IVDUs), with or without thrombocytopenia (TCP). Direct tests demonstrated an increased amount of PAIgs in 40% of the patients, irrespective of their platelet count. These PAIgs were mainly of IgG class and could not be eluted with ether. Plasma IgG with antiplatelet activity was found in 70% of the thrombocytopenic individuals, whereas it was detected in only one patient without TCP. The relative frequencies of antibodies against the platelet glycoproteins (GPs) Ib/IX and IIb/IIIa were assessed in plasma from all patients by means of the monoclonal antibody-specific immobilization of platelet antigens assay (MAIPA). Plasmas from all non-thrombocytopenic patients were negative when tested by indirect MAIPA. In contrast, 10/23 plasma from thrombocytopenic patients reacted with either GP IIb/IIIa, GP Ib/IX, or both GPs. Finally, aiming to investigate whether HIV antibodies from these patients are reactive with normal platelets, we performed absorption-elution experiments, followed by evaluation of HIV antibodies in the indirect eluates by ELISA and Western blot. Interestingly, we detected anti-HIV antibodies that bind to normal platelet antigens in 50% of the ether eluates prepared from control platelets sensitized with plasma from patients with TCP, but in only 5% of eluates obtained from platelets sensitized with plasma from non-thrombocytopenic patients. The present study provides direct evidence that specific autoantibodies against platelet membrane GPs Ib/IX and IIb/IIIa are common in HIV positive thrombocytopenic individuals. The finding in these patients of HIV antibodies cross-reactive with normal platelets, suggests that mimicry of human antigens by HIV could play a key role in the pathophysiology of the HIV-related TCP.

Adult↗
PubMed1996

Exercising purchasing power for preventive care.

Public and private purchasers can shift the focus of the health care system from managing the delivery of medical services to improving health. We report on the efforts of the Pacific Business Group on Health to include health promotion and disease prevention in its definition of health care value, to pay health plans based on their performance in providing appropriate preventive care, and to encourage employers and workers to choose health plans that excel in promoting health. This example serves as a model for other purchasing groups by combining economic incentives and systems of accountability to achieve public health goals.

California↗
PubMed1996

Prevalence of hepatitis B and C markers in the south-east of Spain: an unlinked community-based serosurvey of 2,203 adults.

We conducted an unlinked seroprevalence survey in a community-based sample of 2,203 adults to estimate the prevalence of hepatitis B and C virus markers in the general adult population of the Murcia region (Spain). The influence of age, sex and place of residence on the seroprevalence of hepatitis was investigated. The overall prevalence was 10.2% for anti-HBc antibodies, 0.9% for HBsAg, and 1% for anti-HCV. There was a trend of increasing prevalence with age for anti-HBc and anti-HCV regardless of sex and urban or rural residence. The prevalence of hepatitis B and C markers was higher in individuals living in urban areas, although there was no significant association. The results indicate that the Murcia region may be considered an area of low-intermediate endemicity for hepatitis B virus infection. This is one of the first reports assessing the prevalence rate for hepatitis C markers for a general population in Europe.

Adolescent↗
PubMed1996

Health education and patient satisfaction.

BACKGROUND: The objective of this research was to determine whether patients who reported that their physician or other health care professional had discussed health education topics with them were more satisfied with their physician than were patients who reported they had not. METHODS: Data were from the 1994 Health Plan Value Check conducted by the Pacific Business Group on Health (52% response rate). The study sample included 5066 employees ranging in age from 19 to 64 years and representing four large corporations and 21 health plans. This population was randomly sampled by company and health plan. Bivariate and multivariate analyses were used to assess the relationship between level of patient satisfaction with physician and reported discussion of health education topics with a physician or other health professional in the last 3 years. RESULTS: Patients who reported that their physician or other health care professional discussed at least one health education topic with them in the last 3 years were more likely to be satisfied with their physician (unadjusted odds ratio [OR] = 1.96; 95% confidence interval [CI] 1.79 to 2.25) compared with patients who did not. In the multivariate model, the relationship remained positive and statistically significant (adjusted OR = 1.49; 95% CI, 1.32 to 1.68). This relationship was observed for patients enrolled in all types of HMOs and managed care plans, as well as those with indemnity or fee-for-service insurance. CONCLUSIONS: Patients who reported that their physician or other health care professional had discussed one or more health education topics with them in the last 3 years were more likely to be very satisfied with their physician than were patients who reported they had not.

Adult↗
PubMed1996

Nutritional status of CAPD patients at three years.

A nutritional assessment was carried out in 63 patients starting treatment from April 1990 up to December 1993. Anthropometric measurements were performed showing a prevalence of protein-calorie malnutrition (PCM) of 21% in a total of 142 clinical surveys carried out in the above-mentioned sample. A steady state of albumin levels in plasma was verified during a three-year follow-up period at a lower level than that of the control group. The patients' lymphocytic profile throughout the study was characterized by lymphopenia and decreased B and T8 lymphocytes. During the first two years of continuous ambulatory peritoneal dialysis (CAPD), a high percentage of patients met the "adequacy" dialysis criteria as residual renal function plays an important role as regards treatment.

Adult↗