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Biomedical subjects

B Costa

Publications and source records attributed to B Costa.

At least 73 records · Page 4Linked to original sources
PubMed1995

[Diabetes and ignored disorders of glucose tolerance in primary care. Evidence from opportunistic detection. Group for the Study of Diabetes in Tarragona].

OBJECTIVE: To investigate the level of attendance for care of people with glucose tolerance disorders, both known and not, and to discuss their real impact on Primary Care. DESIGN: Simple prospective randomised sampling. Opportunist detection among spontaneous users over 40, excluding pregnant women. SETTING: Primary Health Care. PATIENTS AND OTHER PARTICIPANTS: Data was recorded using a pre-designed survey, which included the recognised Diabetes (DM) risk factors. MEASUREMENTS AND MAIN RESULTS: Of the 183 cases evaluated, DM was already known in 13 (7.1%). 15 (8.2%) with unknown DM and 27 (14.7%) with GIT. A strong link was demonstrated with the average age and a marked tendency to overweight and obesity only significant when comparing DM with the rest. As to the risk factors researched, there was a significant association with antecedents of prior tolerance abnormality, DM in pregnancy, hyperglucaemiant medicines and ischaemic disease, in cases where family antecedents of definite diabetes were not found. CONCLUSIONS: The frequency of attendance of users with diabetes and unknown glucose tolerance disorders is very high in spontaneous primary care consultations. These results suggest that opportunist detection should be encouraged in primary health care centres.

Adult↗
PubMed1995

[Diabetes and pharmacoeconomics. Efficiency of insulin injection methods available in Spain].

OBJECTIVES: In Spain today there are three ways of injecting insulin, the traditional syringe (TS) and two automatic methods: injector pens (IP) and preloaded syringes (PS). The main aim of the study was to compare their efficiency in normal use; and the second, to compare their effectiveness in terms of how they suited the clinical profile and needs of the users. DESIGN: A pharmacoeconomical study to minimise costs. SETTING: Two Primary Care clinics, one specialising in diabetes and the other not, and a third clinic, part of hospital out-patients. PATIENTS AND OTHER PARTICIPANTS: Systematic examination of the insulin packages and the material used by 108 diabetics (3 groups of 36, divided by the method of injection) over an average period of 51 days. MEASUREMENTS AND MAIN RESULTS: The average dose prescribed was 34.7 units (U) per day, supplied in 2.2 injections per day. The real average dose consumed was 41.4 U per day with an average daily loss of 3.1 U per injection and average re-use of needles at 7.1 times per patient. Type 11 diabetics, older patients and those with worse eye sight used TS more often. Younger and Type 1 diabetics and those who needed more injections generally used an automatic method, in particular IP. PS seemed to be used by both types of diabetic indifferently. There were significant differences found between users of TS, IP and PS regarding the doses taken (44.6, 45.1 and 34.5 U; p < 0.03), the daily loss per injection (4.5, 3.2 and 1.4 U; (p < 0.0004) and in the re-use of needles (4.1, 7.7 and 8.1 times; p < 0.02). CONCLUSION: If we suppose similar efficacy, automatic systems are more efficient in reality than traditional syringes and insulin vials.

Adolescent↗
PubMed1994

[Drug consumption in diabetes mellitus (IV). The utilization of reactive material and systems for assessing blood glucose control from the viewpoint of primary care. The Group for the Study of Diabetes in Tarragona (GEDT)].

BACKGROUND: A study was performed to analyze the use of reactive material in the periodic follow up of diabetes. Likewise, the use of systems to assess glycemic control by primary care physicians was investigated. METHODS: Analysis of the habits of use of reactive material was performed on the diabetic population of Tarragona (548,900 inhabitants) by randomized survey of prescription in 525 patients attended in 12 primary care centers. The estimation of amount was carried out by a counting of the public prescriptions made. Similarly the periodicity and the results of the applications of glucoproteins in the reference laboratories were studied. RESULTS: A total of 253 diabetics (48%) were exclusively attended in the centers and 272 (52%) performed some type of home self-analysis; 26 (5%) in urine samples, and 246 (47%) in capillary blood. The estimated mean consumption was of 14 blood sugar strips per patient per month (168 strips/year) and 2.7 glucosuria-glucocetonuria strips (32.4 strips/year). The relative urine/blood ratio was 1/5.2. In 343 cases (65%) some glucoprotein measurement was reported within the last year, 330 (63%) corresponding to glucohemoglobin A1. The mean value was 8.3% (normal: 5-8%). The mean number of applications was 1.6 applications per patient per year. CONCLUSIONS: An enormous increase was observed in the amount consumed at the province of reactive material in blood and in the measurement of glucoproteins as the system to assess carbohydrate control in diabetes. A significant reduction was found in the use of reactive strips in urine by the diabetic population.

Blood Glucose↗
PubMed1994

Hemiparkinsonism-hemiatrophy syndrome: neuroradiological and neurophysiological findings.

A rare form of secondary parkinsonism has been recently described as 'hemiparkinsonism-hemiatrophy syndrome'. We report a case with such clinical features. A neurophysiological study of the evoked potentials, somatosensory and motor, has been conducted. We stress the neuroradiological findings at nuclear magnetic resonance, which documented the presence of an area of altered signal in the mesencephalon, between the cerebral pedunculus and the red nucleus on the right side. The etiopathogenetic considerations and diagnostic criteria are discussed. Moreover we evaluate the efficacy of levodopa therapy.

Adult↗
PubMed1993

[Drug consumption in diabetes mellitus (III). Trends of hypoglycemic agents use and consumption in Tarragona, Catalonia, and Spain (1988- 1991). Group for the Study of Diabetes in Tarragona].

BACKGROUND: To analyze the evolution of the use of drugs in diabetes, the consumption of hypoglycemic medication in the province of Tarragona, the autonomic community of Catalonia and Spain as a whole, was studied. A qualitative evaluation of the tendencies of prescription, as an indirect index of quality in the health care to diabetics was performed. METHODS: The sales of oral hypoglycemic medication (OH) and insulin (INS) were accounted for in the study environment between 1988-1991. To make consumption uniform a standardized unit of measure was used with defined daily doses (DDD)/1,000 inhabitants/day (Drug Utilization Research Group) of the different groups of drugs. Total consumption was obtained by a primary data source (Intercontinental Medical Statistics), and periodically compared with a secondary source (registry of public prescriptions within Tarragona). RESULTS: A progressive increase in the consumption of hypoglycemic drugs was observed: 16.1 to 21.2 DDD/1,000 inhabitants/day (31%) in Spain; 17.7 to 19.8 (12%) in Catalonia and 19 to 23 (21%) in Tarragona. The increase in consumption of INS in Tarragona (43%) was greater than that of OH (12%). In Catalonia, it was much greater (INS: 23%, OH: 7%) and was parallel in Spain (36% and 30%, respectively). The OH/INS index decreased in Catalonia and Tarragona (1.3 and 1.9 in 1991) and remained practically constant (2.3-2.4) in Spain. A global decrease was produced in the consumption of slow insulins with a significant increase in intermediate, premixed and fast insulins. A growing increase in glibenclamide much greater than the remaining sulphonylureas was seen, in addition there was a persistent and low use (less than 1 DDD/100 inhabitants/day) of biguanides. Significative variations of medication consumption were registered according to the territory analyzed. CONCLUSIONS: From 1988 to 1991 there has been an increase in the use of hypoglycemic drugs. The use of oral hypoglycemics has remained constant in relation to insulins in Spain and in Catalonia and, more so in Tarragona, there is a progressive inclination to the use of insulin. The evolution of consumption suggests important asymmetry in the quality of health care and denotes progression in the global educative offer to diabetics.

Diabetes Mellitus↗
PubMed1993

[Consumption of drugs in diabetes mellitus II. Utilization and loss of insulin: epidemiologic and socioeconomic implications. Study Group for Diabetes in Tarragona (GEDT)].

BACKGROUND: With the aim of evaluating the real consumption on insulin an analysis of its loss with use in clinical practice was carried out. The influence of this loss was investigated in the calculations of prevalence of diabetes (DM) initiating from the consumption of medication, the presumable repercussion in public health costs and possible alternatives. METHODS: Revision and analysis of the recipients used by a group of 58 insulin treated diabetics was carried out during a mean period of one month. The theoretic consumption, real consumption and the mean loss per each injection according to visual accuracy and the system employed were evaluated. A deduction was made of the autonomy by storing of insulin. A previous calculation concerning the prevalence of DM in Tarragona (548,900 inhabitants) according to consumption was corrected and an economic estimation of the loss demonstrated over public health costs of insulin during 1991 was made. RESULTS: The mean dose prescribed was 39.7 IU/day supplied in 2.4 injections/patient/day. At 30 days (27-35) 310 recipients were evaluated (115 vials/195 boxes). The mean real dose consumed was 53.3 IU/day and the mean loss per injection was 5.6 (25.5% of all the insulin supplied, 4.5% as remnants at the bottom of the recipient). A greater loss was observed by injection a) in patients with reduced sight (6.4 +/- 7.3 IU/5.5 +/- 4.5; NS) and b) in the users of syringes with dead space (5.8 +/- 4.7) with respect to those using an injector insulin pen (4.4 +/- 2.9; p < 0.01). The autonomy by domiciliary storage of insulin was of 103.7 days/patient (prescribed doses) and 78.6 (real consumption). A total of 7 diabetics (12%) had unused expired recipients. The prevalence of insulin treated DM in Tarragona was estimated as around 4.3-4.8/1,000 (2,360-2,635 inhabitants). The expense of loss was 36 million pesetas/year; 6.4 as depreciated remnants of insulin in the bottom of recipients. CONCLUSIONS: There is a great loss of insulin in clinical practice which may be avoidable and which influences the public health costs for diabetes. An adequate educative strategy and system of injection independent of user ability would reduce the costs.

Adolescent↗
PubMed1993

Short term prognosis of stroke in a clinical series of 94 patients.

We conducted a study on the factors predictive of early mortality (within 30 days of onset of symptoms) in a clinical series of 94 patients at their first stroke. Irrespective of the type of stroke, ischemic or hemorrhagic, early mortality proved to correlate with clinical parameters, such as coma at onset, presence of paralysis, changes in ocular motility, and neuroradiological parameters (lesion size on the CT scan) indicative of stroke severity.

Adult↗
PubMed1992

[Drug consumption in diabetes mellitus (I). Estimate of the therapeutic profile and the prevalence in the regions of Tarragona (548,900 inhabitants). Grup per a l'Estudi de la Diabetis a Tarragona].

BACKGROUND: This study was carried out to estimate the treatment characteristics and prevalence of diabetes mellitus (DM) diagnosed in the counties of Tarragona (548,900 inhabitants) from the consumption of hypoglycemic medication. METHODS: A stratified aleatory sample was made of the prescription of oral hypoglycemic agents (OHA) and insulin (INS) in 14 centers of primary health care. Calculation of pharmacy dispensing and prescriptions (computer network of the Institut Català de la Salut) was carried out with a relation of the mean doses of the survey and the estimate of the consumer population being made. A contrast was made of the system with the daily doses defined (DDD/1,000 inhabitants/day) of the different OHA and INS preparations. RESULTS: Following aleatorization a representative sample of 550 diabetics, 64 (11.6%) type I and 486 (88.4%) type II was obtained. In total, 61 were treated with diet alone (IC 95%; 8-13%, p less than 0.05); 249 (41-49%) with OHA (51% of type II) and 240 (39-47%) received insulin, all the type I and 176 (36%) type II. In 23 cases (2-5%) multiple therapy with different drugs was confirmed and 72 (10-15%) were treated with the maximal doses of OHA recommended. The rate of OHA/INS was 2.02-2.05. The prevalence of pharmaco-treated DM was 1.9% (prescriptions of public health) and 2.1-2.3% (total consumption). The method for DDD was evaluated as between 1.8% (prescriptions) and 2.0% (total consumption). Globally, during 1990 the prevalence of DM diagnosed in Tarragona was estimated as between 2.1-2.5%. CONCLUSIONS: The estimation of the prevalence of diabetes mellitus indicated higher numbers than those obtained in other studies providing a first line indicator for the planning of care for diabetics in this demarcation. The study also identified the real therapeutic tendencies permitting the extraction of lines of action for the education of diabetics and the formation of professionals attending these patients.

Diabetes Mellitus↗
PubMed1992

Coma of vascular aetiology: evaluation and prognosis.

The authors have done a revision of 450 patients admitted during the last 3 years to the emergency service of the Hospital de S. José with the diagnosis of CVA. In this retrospective study were included the patients of greater than or equal to 3 degree of the RLS/85 coma scale, the diagnostic being confirmed by CAT, angiography and/or autopsy, and simultaneously evaluated by the Glasgow coma scale. The studied population was grouped into: SAH; ICH with or without ventricular drowning, cerebellar haematoma, brainstem haematoma, ischaemic CVA. The factors of vascular risk: diabetes and hypertension, the age of the patients and coma level were correlated with the degree of cerebral disability of discharge in all patients. The following factors are clearly related with bad prognosis: coma of degree greater than or equal to 4 in the RLS/85 scale; ischaemic aetiology; intraventricular haemorrhage.

Adult↗
PubMed1992

Dementia of Alzheimer type (DAT) in a man chronically exposed to pesticides.

A patient chronically exposed to pesticides with dementia of Alzheimer type (DAT) is presented. We evaluate the pathogenic role of these substances in the disease and suggest the usefulness of an epidemiological attention on the environmental factors in certain neurodegenerative diseases.

Alzheimer Disease↗
PubMed1991

[Evaluation of a program for the care of the diabetic. A 40-month continuity study].

BACKGROUND: To evaluate the long term efficacy of a program of attention to diabetes mellitus. METHODS: A continued 40-month follow-up study in a group of 47 diabetic patients treated with insulin (21 type I and 26 type II) with a mean age of 45.8 years and a mean duration of diabetes of 8.1 years. These patients were seen in the hospital outpatient clinic during the initial 12 months and in community clinics during the remaining 12 months. RESULTS: Mean basal glycemia (7.4 +/- 1.5 mmol/l) and HbA1 (8.3 +/- 1.1%) at 40 months were significantly lower than those in the initial 12 months (8.8 +/- 2.4 mmol/l and 9.2 +/- 1.2%; p less than 0.001) and in the beginning of the study (4.2 mmol/l and 11.2 +/- 1.9%; p less than 0.0001). In type II diabetics, cholesterol and triglyceride levels showed a significant reduction from the mean first year levels (6.2 +/- 0.9 and 1.6 +/- 0.9 mmol/l) to those in the 12-40 months period (5.8 +/- 0.8 and 1.3 +/- 0.5; p less than 0.01 in both instances). Initially, 22 diabetics (46%) used rapid acting insulin; at the end, 37 had included these preparations in their treatment (78%; p less than 0.001). Only 7 patients (14%) used multiple insulin doses at the beginning. After 40 months, 29 (61%) were treated with 3-4 insulin injections per day (p less than 0.0001). In 43 patients (91%) no severe hypoglycemic crisis had developed. In 45 (95%) macroproteinuria was not detected and 40 (85%) had not developed microangiopathic lesions in the retina or microangiopathic involvement elsewhere as evaluated with the available techniques. Psychical depression was evaluated at 40 months using a semiquantitative scale questionnaire. The overall responses in the intervention group (n = 20; 25.4 +/- 4.6) showed lower depression levels (higher scores) than a control group ( n = 22; 22.4 +/- 4.9; p less than 0.02) constituted by diabetics with similar characteristics but who had not been following the program. CONCLUSIONS: The programs for the attention to the diabetic are effective in the long term to achieved and sustain metabolic control, the acquired knowledge and, to a sizeable degree, the compliance with therapy, provided that they integrate the teaching with the treatment. It is very likely that these programs reduce the risk of late features of the disease and the tendency to depression, independently from the place where the patient is controlled.

Adolescent↗
PubMed1991

Rigidity and painful muscle spasms in a patient with probable myelitis.

We describe a case of continuous motor unit potential (MUP) activity of central origin (unlike stiff man syndrome and progressive encephalomyelitis) characterized clinically by rigidity, painful muscle spasms, abnormal postures and spinal myoclonus. The topography of the manifestations, the subacute and benign course, the presence of stable sequels 2 years after onset and a searching process of differential diagnosis lead us to attribute the condition to an inflammation of the cord, which makes the case of particular clinical interest.

Adult↗