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Biomedical subjects

C Molina

Publications and source records attributed to C Molina.

At least 217 records · Page 12Linked to original sources
PubMedDate not supplied

[The influence of the arterial pressure in the study of cerebrovascular reactivity in carotid obstructions].

INTRODUCTION: Cerebrovascular reactivity (CVR) is the capacity of the cerebral microcirculation to increase cerebral blood flow on vasodilator stimulation. This is reduced in patients with carotid obstruction. The changes in arterial pressure produced whilst carrying out different tests for estimation of the CVR may affect its measurement by transcranial Doppler. OBJECTIVES: To evaluate the concordance between the different methods for estimation of the CVR by transcranial Doppler in patients with carotid obstruction and to evaluate the importance of monitoring the arterial pressure during CVR tests. PATIENTS AND METHODS: We evaluated 17 patients with internal carotid artery obstruction confirmed on arteriography. The CVR was determined by three different methods: apnea test. Breath-Holding Index (BHI) and intravenous acetazolamide test. RESULTS: During the tests of RCV the arterial pressure was monitored. We found that there was a reduction in the average basal rate of flow and of the pulsatile index on the obstructed side, with a statistically significant association in relation to the contralateral side (p < 0.001). There was good concordance between the different tests of CVR, with reduced CVR seen on the obstructed side as compared to the contralateral side (p < 0.001) for the different tests. However, this correlation was not seen in stenosis < 70%. During the apnea test changes in blood pressure occurred, with a tendency to increase in the systolic pressure. However, there were no significant changes in blood pressure during the acetazolamide test. CONCLUSIONS: There is good concordance in the CVR between the apnea, BHI and acetazolamide tests in carotid obstruction. Changes in arterial pressure occurred during the apnea and BHI tests. However, the acetazolamide test caused no change in arterial pressure.

Acetazolamide↗
PubMedDate not supplied

[Immunological approach to asthmatic disease (author's transl)].

Research into the environmental factors in the aetiological diagnosis of asthma is a fundamental measure which must direct complementary test and therapy. Extrinsic asthma is mostly found in young people, with atopic antecedents. Immunological study is based on the clinical history and skin tests (IgE dosage, in vitro tests and provocation tests are difficult to apply in epidemiology due to their high cost). In children 3/4 of asthma cases are extrinsic. Differential diagnosis is especially a problem with rhinitis. There is only a small percentage of cases of non atopic extrinsic asthma which can bring other immunological mechanisms into play. So-called intrinsic asthma (late onset asthma, with continuous dyspnea, corticodependent) is mostly observed in adults. The age has an influence on the severity of the attacks, the curve of asthma with permanent dyspnea being a function increasing with age, whereas that of less severe asthma is a function decreasing with age. The role of extrinsic factors does not seem important in this category of asthmatics (10 to 25% according to the statistics). Immunofluorescence studies of the bronchial mucosa show up the possibility of local immunological reactions, whether specific or not (frequent presence of the C3 complement). This means that the immunologist can, in many cases of asthma, help the epidemiologist to define and to understand the physiological mechanisms of the disease.

Adult↗
PubMedDate not supplied

[Correlation between the expression of proinflammatory cytokines and matrix metalloproteinases in the acute phase of an ischemic stroke].

INTRODUCTION: Proinflammatory cytokines are the main responsible for the onset of postischemic inflammatory cascade. Recently, the deleterious effect of matrix metalloproteinases (MMPs) in the acute phase of stroke has been described. Animal models suggest a link between both families. OBJECTIVE: We aimed to investigate possible relations between the MMP overproduction and proinflammatory cytokine expression after human ischemic stroke. PATIENTS AND METHODS: From all consecutive stroke patients attended during a 10 months period, we selected and prospectively studied those presenting as a cardioembolic stroke involving the MCA territory. MMP 9, MMP 2 and IL 6 were serially measured by means of ELISA at study entry and at 12, 24 and 48 hours after symptoms onset. RESULTS: A total of 39 patients were studied. A positive correlation was found between mean expression of both MMPs and IL 6 (r= 0.33, p= 0.040 for MMP 2 y r= 0.45, p= 0.004 for MMP 9). From all measured timepoints, the best obtained correlation was that of MMP 9 with IL 6 at 24 hours (r= 0.418, p= 0.010). At 24 h a peak value of IL 6 was observed. Baseline MMP 2 and MMP 9 levels showed a trend to correlate with that peak of IL 6 (r= 0.329, p= 0.061 for MMP 2 y r= 0.325, p= 0.061 for MMP 9). CONCLUSION: MMP expression correlates with the inflammatory cascade activation after acute cardioembolic stroke.

Acute Disease↗
PubMedDate not supplied

[Chronic subdural hematoma simulating a TIA. Implications for the management transient neurological deficit].

Chronic subdural hematoma that generally happens after cranial trauma doesn't have clinical manifestations until days or weeks after the traumatism. Due to the lesions nature, symptoms are almost always progressive and presentation as transient ischemic attacks (TIA) is very uncommon. We describe 2 cases of chronic subdural hematoma that started simulating TIA and we discuss its implications in the management of those patients who had presented transient neurological deficit.

Aged↗
PubMedDate not supplied

[Migraine and MIDAS (MIDASELA) in Colombian hospital workers].

AIMS: The aim of this study was to determine the prevalence of migraine and its implications in the occupational and outside employment/daily activities of the workers at a regional hospital in the Cundiboyacense Plateau in Colombia. PATIENTS AND METHODS: The available members of the house staff at this institution were interviewed by applying the neuroepidemiological protocol drawn up by the World Health Organization (WHO); general doctors performed the initial screening and the determination of neurological disease was carried out by a clinical neurologist, both in patients who were positive and negative for neurological disease. Quality of life was evaluated by means of the MIDAS (Migraine Disability Assessment) survey, MIDASELA (in Spanish for Latin America); the analysis was performed using the EPI 6.04 software application. RESULTS: A total of 238 people were studied: 188 females and 50 males; the prevalence of migraine was 22.5% (15.5% by the WHO protocol and 7% false negatives), with predominance in females (OR: 5.49; p< 0.005). In the MIDASELA questionnaire, 47.2% of the patients had a 50% alteration in their productivity, with regard to their occupational and outside employment/daily activities. A minimum number of patients (3.8%) were unable to work because of migraine, as compared to the figures for outside employment/daily activities (29.7%) or those involving leisure/family (66.4%). The average work, outside employment/daily and family time lost per patient because of migraine was 0.3, 2 and 5.2 days, respectively. CONCLUSION: A sub register in the prevalence of migraine could be reported in places where the WHO protocol is used. This pathology will have to be taken well into account in Colombian hospital workers due to its individual, occupational, family, social and economic impact. It is necessary to introduce health policies and programmes aimed at evaluating, controlling and treating this type of pathology in an appropriate manner, in order to improve the quality of life of those whose job it is to look after and improve that of the other Colombians.

Adult↗
PubMedDate not supplied

[Role of homocysteine in the acute phase of stroke].

INTRODUCTION: Hyperhomocysteinemia is a well known vascular risk factor. However its action mechanism and its role in the acute phase of stroke have not been determined. OBJECTIVES: To study plasmatic homocysteine levels in the acute stroke of different etiologies and evaluate its role as a prognostic factor. METHODS: We determined plasmatic homocysteine in 136 consecutive patients with stroke. Mean time from symptoms onset was 4.6 hours. RESULTS: Higher than normal homocysteine levels were found in ischemic stroke (n= 119 13.1 micromol/l; 43 % of patients > normality rank) and intracranial hemorrhage (n= 17 micromol/l; 24 % of patients > normality rank). The etiological distribution of ischemic stroke was the following: 42 cardioembolic (29.4%; median Hcy: 13.1 micromol/l), 20 atherothrombotic (14 %; Hcy: 12.7 micromol/l), 33 lacunar (23.1 %; Hcy: 11.8 micromol/l) and 24 undetermined (16.8%; Hcy:15.2 micromol/l). No significant differences were found between these groups (p=0.19). Those patients who presented early neurological deterioration presented higher homocysteine levels than those who remained stable or improved (median 13.3 n=16 v 11.3 n=113; p=0.061). CONCLUSIONS: High homocysteine levels are associated to all etiologic stroke subtypes and intracranial hemorrhage. Patients who experienced early neurological worsening tend to have higher homocysteine levels.

Acute Disease↗
PubMedDate not supplied

[Left ventricular mechanics in Chagas' disease and primary dilated myocardiopathies. A hemodynamic study].

The evolution of several mechanical parameters of left ventricular function was studied in 32 control subjects, 171 chronic chagasic and 60 primary dilated cardiomyopathy patients, which were submitted to an extensive invasive and non-invasive protocol. Preload and afterload (end-diastolic and end-systolic stress), contractile status (ejection fraction), the magnitude (mass/index) and adequacy of hypertrophy (mass/volume ratio) and afterload (systolic stress/volume ratio) were derived from the invasive explorations. There was an increased afterload in 25% of chronic chagasic patients without other evidence of early myocardial damage, which was accompanied by signs of inadequate hypertrophy. Both findings increased further with the progression of the disease. Systolic performance was initially preserved, but showed a progressive depression paralleling the clinical evolution. Patients with dilated cardiomyopathy showed a mechanical profile similar to chagasic patients with advanced degree of myocardial damage. The hemodynamic determination of mass index, mass/volume ratio, end-systolic and end-diastolic stress seem to be the best parameters for detection of early abnormalities in loading conditions of the heart in chronic Chagas, disease, and for indication and evaluation of the results of vasodilator therapy in both groups of patients.

Adult↗
PubMedDate not supplied

[Chronicle of an announced death: the end of intrinsic asthma].

The word "intrinsic" asthma which is not usually quoted by French authors should be eliminated from the medical vocabulary. Similar past history, clinical symptoms, house or occupational exposure are found in all varieties of asthma. Histological features are the same in atopic asthma and late onset asthma, apparently non allergic. On immunologic point of view there are two types of IgE receptors type I on mastocytes, type II on inflammatory cells, with immunomodulation by IL4 and T lymphocytes. On the other hand, atopic status is an autosomic dominant inherited trait, with a gene locus on the chromosome 11 Q and may be transferred with bone marrow cells graft. Finally asthma appears to be a local variety of IgE hyperresponsiveness to environmental factors. These basic notions have practical consequences and legal aspects.

Asthma↗
PubMedDate not supplied

[Epidemiology of adult asthma (Socio-economic effects) (author's transl)].

A study of the prevalence of adult asthma (subjects over 18 years of age) has been carried out in the Puy-de-Dôme area over the past two years by means of a questionnaire sent out to all the doctors in the area. 1,130 asthmatics have been inventoried to this day (547 males and 583 females). A study of the geographical distribution carried out in terms of demographic data on thhe present time, but is certainly underestimated. Correspondence analysis shows up the influence of age on the severity of the attacks. Frequency calculation and the cumulated frequency of the answers to the question concerning the date of the onset of asthma, leads to the conclusion that there will probably be an important increase of cases of late asthma in the next few years. The socio-economic and professional (sick leave, change of job) effects of this type of asthma in adults are analysed.

Adult↗