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Biomedical subjects

C Rosa

Publications and source records attributed to C Rosa.

At least 19 recordsLinked to original sources
PubMed2001

A phase I/II study of topotecan in combination with carboplatin in recurrent epithelial ovarian cancer.

OBJECTIVE: The purpose of this study was to define the maximum tolerated dose (MTD) of topotecan given as escalating doses combined to a fixed dosage of carboplatin in late relapsing ovarian carcinomas. METHODS: Women with relapsing ovarian cancer more than 6 months after first-line treatment were eligible for the study. In the first phase of the trial, patients were allocated to escalating topotecan doses with a carboplatin fixed dose (AUC 5, according to Cockcroft's formula). If no "severe" adverse event occurred in 1 or more of the patients, the topotecan dose was increased. The starting dose of topotecan was 0.50 mg/m(2)/day, for 3 consecutive days, and the dose step was of 0.25 mg/m(2)/day, till 1.5 mg/m(2)/day. The study progressed then in a phase II trial. RESULTS: A total of 39 patients entered the trial. Twenty took part in the escalating topotecan dose phase (4 per dose level, 0.50, 0.75, 1, 1.25, and 1.50 mg/m(2)/day) and 19 in the phase II. No severe adverse event was observed in the phase I of the trial, so the MTD was not reached. In the phase II trial topotecan was given to 1 mg/m(2)/day. Overall grade 3-4 neutropenia, lasting 7 days or less, was observed in 58.9% (23 patients). Thrombocytopenia occurred in 30.8% (12 patients) and grade 3 anemia in 25.6% (10 patients) of subjects. No life-threatening event occurred. Platelets or red blood cell transfusions were given in three cases (7.8%). CONCLUSIONS: This daily-times-3-day schedule of topotecan in combination with carboplatin is safe.

Adult↗
PubMed2001

Development of a DNA-based method aimed at identifying the fish species present in food products.

Analysis of restriction fragment length polymorphism (RFLP) profiles of a 464 bp amplicon obtained from the mitochondrial cytochrome b gene was used to differentiate between several different fish species. The method was tested by a collaborative study in which 12 European laboratories participated to ascertain whether the method was reproducible. Each laboratory was required to identify 10 unknown samples by comparison with RFLP profiles from authentic species. From a total of 120 tests performed, unknown samples were correctly identified in 96% of cases. Further work attempting to use the method to analyze mixed and processed fish samples was also performed. In all cases the species contained within mixed samples were correctly identified, indicating the efficacy of the method for detecting fraudulent substitution of fish species in food products.

Animals↗
PubMed2001

Identification of Hake species (Merluccius Genus) using sequencing and PCR-RFLP analysis of mitochondrial DNA control region sequences.

The use of DNA-based methodologies in identification of hake species belonging to the Merluccius genus was shown to be successful. A short fragment of the left hypervariable domain of the mitochondrial control region was amplified, sequenced, and digested from 11 hake species. The hake-specific PCR product, due to its limited size, was obtained in a variety of tissue samples with different levels of DNA concentration and degradation, including sterilized food products. On the basis of this phylogenetically informative 156-bp sequence were selected four restriction enzymes (ApoI, DdeI, DraIII, and MboII) that allow the hake species discrimination. Species identification by phylogenetic analysis of sequences or by PCR-RFLP methodologies is useful in a variety of scenarios including authentication of thermally processed food, detection of food components, and species determination of individuals whose morphological characters are removed.

Animals↗
PubMed2001

Identification of flatfish (Pleuronectiforme) species using DNA-based techniques.

Identification of flatfish species using a DNA-based methodology was studied. The polymerase chain reaction was employed to obtain a 464 bp amplicon from mitochondrial cytochrome b gene. The sequences from this fragment belonging to 24 species were analyzed using a genetic distance method, and polymorphic sites were determined. The fragment was found to be highly polymorphic (231 sites), and this permitted the differentiation of most of the species. Phylogenetic tree construction was employed to allow the identification of flatfish species. As a result, each species was grouped in a well-differentiated clade, except for two pairs: Limanda ferruginea and L. limanda, and Solea impar and S. lascaris, which could not be differentiated. On the basis of the sequences obtained, restriction enzymes were selected to provide specific restriction profiles, which allow the differentiation of 21 species of flatfish in a faster and less expensive manner than sequencing. This polymerase chain reaction-restriction fragment length polymorphism methodology (PCR-RFLP) was tested using commercial samples.

Animals↗
PubMed2001

Delayed interval delivery military style.

INTRODUCTION: Intentionally delaying the delivery of a second twin from a previable state to a gestational age when survival is possible is a heroic measure whose outcome is unpredictable. We report the case of delayed interval delivery in a patient transported via air evacuation to a tertiary care center. CASE REPORT: A 31-year-old gravida 3 para 0020 at 18 weeks with a twin gestation presented to a medical treatment facility for evaluation of uterine cramps. She subsequently delivered Twin A. With cessation of labor, the patient was air evacuated to a medical center for continued care. Seven weeks later, she delivered a viable male infant. DISCUSSION: The treatment of multiple gestations presenting with preterm labor or rupture of membranes remains expectant. When delayed delivery of a previable second twin is undertaken, appropriate care includes the use of antibiotics, tocolytics, and cervical cerclage. Anticipation of preterm birth warrants continued care in a tertiary care center offering neonatal intensive care.

Adult↗
PubMed2000

[Evaluation of 2 tuberculosis chemoprophylaxis regimens in patients infected with human immunodeficiency virus. The GECMEI Group].

OBJECTIVE: To assess the compliance, tolerance and efficacy of a short chemoprophylaxis regimen (IR) for tuberculosis using isoniazid (INH) plus rifampin (RIF) during 3 months versus a standard regimen (I) of isoniazid during 12 months in HIV positive patients. MATERIAL AND METHODS: Prospective, comparative, randomized and open clinical trial in four general hospitals and one prison hospital of Castilla-La Mancha. Prophylaxis was administered to PPD-positive patients and to anergic patients according to the CDC recommendations (1991). Patients were randomized in two treatment groups: regimen IR, isoniazid 300 mg daily and rifampin 600 mg daily; regimen I, isoniazid 300 mg during 12 months. RESULTS: 133 patients were included, 64 to regimen I and 69 to regimen IR. Regimen IR had a better tolerance with a 28% of adverse effects versus 55% in regimen I. Hepatotoxicity was more frequent in regimen I with a RR = 2.2 (CI 95% 1.23-4.01). Severe hepatotoxicity leading to treatment withdrawal was related to drug administration time and was more frequent in the 12 months regimen group. Short regimen showed a better compliance, without significant differences. Tuberculosis incidence rate was a 4.23 cases/100 persons--year for regimen I and 2.08 in regimen IR, with a relative risk for developing tuberculosis with regimen IR group of 0.51 (CI 95% 0.09-2.8) versus regimen I group, without statistical significance. Prison stay was associated to a significant risk for tuberculosis, regardless of both regimens (RR = 9.2 CI 95%, 1.06-80.2). CONCLUSIONS: In HIV-infected patients with PPD(+) or anergic, regimen with IR is at least as effective as regimen I for preventing the development of tuberculous disease, and has less adverse effects.

AIDS-Related Opportunistic Infections↗
PubMed2000

Transgene expression driven by heterologous ribulose-1, 5-bisphosphate carboxylase/oxygenase small-subunit gene promoters in the vegetative tissues of apple (Malus pumila mill.).

It is desirable that the expression of transgenes in genetically modified crops is restricted to the tissues requiring the encoded activity. To this end, we have studied the ability of the heterologous ribulose-1,5-bisphosphate carboxylase/oxygenase (Rubisco) small-subunit (SSU) gene promoters, RBCS3CP (0.8 kbp) from tomato (hycopersion esculentum Mill.) and SRS1P (1.5 kbp) from soybean (Glycine max [h.] Mers.), to drive expression of the beta-glucuronidase (gusA) marker gene in apple (Malus pumila Mill.). Transgenic lines of cultivar Greensleeves were produced by Agrobacterium-mediated transformation and the level of gusA expression in the vegetative tissues of young plants was compared with that produced using the cauliflower mosaic virus (CaMV) 35S promoter. These quantitative GUS data were assessed for their relationship to the copy number of transgene loci. The precise location of GUS activity in leaves was identified histochemically. The heterologous SSU promoters were active primarily in the green vegetative tissues of apple, although activity in the roots was noticeably higher with the RBCS3C promoter than with the SRS1 promoter. The mean GUS activity in leaf tissue of the SSU promoter transgenics was approximately half that of plants containing the CaMV 35S promoter. Histochemical analysis demonstrated that GUS activity was localised to the mesophyll and palisade cells of the leaf. The influence of light on expression was also determined. The activity of the SRS1 promoter was strictly dependent on light, whereas that of the RBCS3C promoter appeared not to be. Both SSU promoters would be suitable for the expression of transgenes in green photosynthetic tissues of apple.

Agrobacterium tumefaciens↗
PubMed2000

Use of restriction fragment length polymorphism to distinguish between salmon species.

Identification of 10 salmon species using DNA-based methodology was investigated. Amplification of DNA was carried out using a primer set which amplified a region of the mitochondrial cytochrome b gene. Sequences of PCR-amplified DNA from the salmon species were used to select six restriction enzymes allowing species to be uniquely classified. RFLP patterns generated following analysis with each enzyme were resolved using polyacrylamide gel electrophoresis and visualized by silver staining. Results indicate that it is possible to differentiate between all 10 salmon species and that the technique could be easily adopted by the food industry for analysis of processed salmon products.

Animals↗
PubMed1999

Delayed interval delivery in multiple gestations.

The incidence of higher-order gestations is increasing primarily as a result of menstrual cycle manipulation, with concomitant increased risk in maternal and fetal complications. Perinatal mortality rates range between 47 and 120 per 1000 births for twins and 93 to 203 per 1000 births for triplets. The critical period of perinatal mortality and morbidity is between weeks 23 and 28 of gestation. Attention has recently turned to methods of delaying the birth of second and higher order fetuses to improve newborn survival and decrease neonatal morbidity in these high-risk pregnancies. We report two cases of delayed interval delivery. Neither pregnancy involved a monochorionic/monoamniotic gestation. The first case was a twin gestation delivered at 21 weeks with an interval of 5 days and extreme prematurity of both twins. The second case was a triplet gestation delivered at 21 weeks with an interval of 5 days. Triplet A was stillborn; triplets B and C succumbed in extreme prematurity. Preterm labor in multiple gestations usually results in delivery of all fetuses. On occasion, the uterus will spontaneously cease to contract after the birth of one or more premature infants. Review of the literature now reports 48 twin pregnancies exposed to delayed interval delivery with 40 surviving infants of 96 fetuses. Whereas delaying the delivery of remaining fetuses improves their prognosis, there is currently no consensus regarding technique nor is there statistical significance in techniques currently used. Furthermore, study is indicated to reduce preterm birth and associated costs.

Adult↗
PubMed1999

A survey of military residencies regarding 4th-year medical school clerkships.

OBJECTIVE: To determine the value of 4th-year medical student clerkships assessed by military obstetric and gynecologic program directors and residents. METHODS: A questionnaire was sent to all Department of Defense obstetric and gynecologic residency program directors and residents. All of the program directors and 124 of 194 (64%) residents responded, reporting the value of 4th-year medical student clerkships for students entering their programs. Descriptive statistics are reported. RESULTS: Primary care clerkships were valued most highly by program directors who valued obstetric and gynecologic clerkships at their program sites or audition electives higher than those done at other sites. Residents most highly valued obstetric and gynecologic and intensive care clerkships. Most surgical subspecialties were believed to be of minimal or no value. CONCLUSION: For students entering their programs, military program directors placed the highest value on primary care clerkships. Program directors also highly valued obstetric and gynecologic clerkships at their programs, whereas residents considered obstetric and gynecologic and intensive care clerkships to be most helpful.

Clinical Clerkship↗
PubMed1998

Rubella and rubeola.

Rubella and rubeola are common viral exanthems that may affect women of reproductive age. Effective vaccination programs have greatly decreased their incidence. Although Rubella is a relatively innocuous illness for the nonpregnant patient, transplacental fetal infection with rubella can result in significant and crippling fetal malformations and handicap. Because some women of reproductive age are not appropriately immunized, rubella is still a threat. The practitioner needs to be vigilant in assuring vaccination of susceptible individuals when seen for routine health maintenance. Additionally, at times the obstetrician will be challenged with the evaluation and care of a susceptible pregnant patient who is exposed to rubella. In contrast, rubeola (measles) infection during pregnancy has not been associated with congenital malformations. Affected mothers, however, experience a higher incidence of spontaneous abortions and premature delivery and are themselves at risk for serious complications such as pneumonia and encephalitis.

Female↗
PubMed1997

Randomized trial of two doses of the prostaglandin E1 analog misoprostol for labor induction.

OBJECTIVE: Our purpose was to compare the safety and effectiveness of intravaginally administered misoprostol at doses of 25 micrograms and 50 micrograms for indicated labor induction in patients with an unfavorable cervix. STUDY DESIGN: Three hundred ninety-nine patients received either 25 micrograms or 50 micrograms of misoprostol, placed intravaginally in the posterior fornix, in this randomized double-blind trial. The dose was repeated every 3 hours until adequate labor was achieved (at least three contractions in 10 minutes). RESULTS: Among 399 patients evaluated, 192 patients were allocated to the 25 micrograms group and 207 patients to the 50 micrograms group. The start-to-delivery interval was shorter in the 50 micrograms group (826 minutes vs 970 minutes, p = 0.02). The incidence of vaginal delivery after one dose was higher in the 50 micrograms group (38.2% vs 25.0%, p = 0.007). Patients receiving 25 micrograms required oxytocin augmentation more frequently than did those receiving 50 micrograms (27.1% vs 16.9%, p = 0.02). No differences were noted in the cesarean or other operative delivery rates among patients in the two treatment groups. The incidence of newborns with a cord pH < 7.16 was greater in the 50 micrograms group (13.0% vs 6.8%, p = 0.04). Although the incidence of hyperstimulation was similar between the groups, the incidence of tachysystole was higher in the 50 micrograms group (32.8% vs 15.6%, p = 0.0001). CONCLUSIONS: Although a dose of 50 micrograms is associated with a shorter start-to-delivery interval and a higher incidence of vaginal delivery after one dose, 25 micrograms of intravaginal misoprostol is effective and associated with a lower incidence of tachysystole and cord pH values < 7.16.

Administration, Intravaginal↗
PubMed1997

The epidemiology of gestational trophoblastic disease.

Considerable progress has been made in the knowledge of the epidemiology of gestational trophoblastic disease (GTD) in the last few years. There are two main and widely known points related to this disease: its geographical distribution and the different frequency in the various classes of age. GTD is more frequent in South-East Asia, India and Africa, and is rare in European and North American populations. For example, in the United States, the frequency of GTD was 108 per 100,000 pregnancies in the 1970's. In Europe, particularly in Italy, frequencies are lower. In northern Italy, the frequency of hydatidiform mole, in the period 1979-1982, was equal to 62 per 100,000 pregnancies, but in Indonesia and in China, the reported rates were 993 and 667 per 100,000 pregnancies respectively. GTD disease is more frequent in the extreme classes of age (under 20 and over 40 years) and the risk may be more than 100 times greater over 50 years. Besides these risk factors, the possible role of both genetic (familiarity, blood groups) and environmental factors (diet, cigarette smoking, etc.) has been investigated on the onset of GTD. This paper reviews the epidemiologic knowledge on GTD.

Adolescent↗
PubMed1996

Transplacental passage of recombinant human granulocyte colony-stimulating factor in women with an imminent preterm delivery.

OBJECTIVE: We attempted to determine, in a pilot study, whether recombinant human granulocyte colony-stimulating factor, administered to women with an imminent delivery at < or = 30 weeks' estimated gestational age, crosses to the fetal circulation and stimulates fetal neutrophil production. STUDY DESIGN: We measured granulocyte colony-stimulating factor and neutrophil concentrations in the blood of the mothers and in the umbilical venous cord blood after a single intravenous dose (25 micrograms/kg) of recombinant granulocyte colony-stimulating factor given to 11 women in whom preterm delivery was imminent and compared these with values from 34 control women and 35 cord sera. RESULTS: Ten infants were delivered within 30 hours (10.8 +/- 8.9, mean +/- SD) of the granulocyte colony-stimulating factor administration ("early delivery"), and two were delivered after 54 and 108 hours, respectively. In the early delivery group maternal granulocyte colony-stimulating factor concentrations and blood neutrophil levels were higher than in controls. However, no difference was seen in the cord blood neutrophil concentrations. In the late delivery group, although maternal serum and cord blood granulocyte colony-stimulating factor concentrations did not differ from controls, cord blood neutrophil levels were higher (25,900 and 17,700 cells/microliters) than controls (3500 +/- 2000 cells/microliters, p < 0.05) and remained elevated for 1 week. Specifically, the blood neutrophil levels on days 5 and 8 were 12,000 and 17,000, respectively, for these patients, whereas the reference range upper limit for controls was 6000 cells/microliters. CONCLUSION: Administration of recombinant granulocyte colony-stimulating factor to pregnant women with an imminent preterm delivery may result in the transplacental passage of a measurable quantity of granulocyte colony-stimulating factor, an amount that can have a biologic effect on the fetus. These events were most noticeable in those patients who received granulocyte colony-stimulating factor at least 30 hours before being delivered of their infants.

Bacterial Infections↗
PubMed1996

The efficacy of intrathecal injection of sufentanil using a microspinal catheter for labor analgesia.

Intrathecal sufentanil can provide labor analgesia. We investigated the efficacy of multiple injections and the maternal and neonatal effects of intrathecal sufentanil during labor. Seventeen healthy women in active labor received multiple injections of intrathecal sufentanil of 5 micrograms each through microspinal catheters. Overall maternal satisfaction of analgesia was quantified using 10 cm visual analogue scales and side effects were evaluated. Neonatal outcome was also determined. Onset of analgesia was less than 5 min after the first injection and lasted approximately 148 min. Tolerance developed for the successive injections. The mean onset times were 12.9 and 20.1 min and the durations were 76.6 and 33.9 min for the second and third injections, respectively (P < 0.05). Failure to obtain analgesia developed in all patients after the forth injection. No motor blockade was observed in any of the patients. Mild or moderate pruritus developed in 88% of the patients. Mean systolic blood pressure decreased by a maximum of 11.3% at 30 min and up to 90 min (P < 0.05) after the first injection; three patients required ephedrine treatment. No significant hemodynamic changes were observed after subsequent injections. Five patients experienced transient decrease in sensation. Neonatal status, as evaluated by Apgar scores, Neurological Adaptive Capacity Scores (NACS), fetal heart rate (FHR), and umbilical cord acid-base status, were within normal limits. Results from our study suggest that multiple small doses of sufentanil administered intrathecally provided satisfactory analgesia for parturients with short duration of labor since acute tolerance developed with multiple injections. High incidence of mild or moderate pruritus was observed during the study. Close attention should be given to hemodynamically unstable patients when this technique is applied.

Adult↗
PubMed1996

Operative laparoscopy for the treatment of ectopic pregnancy in a residency program.

OBJECTIVE: To compare the effectiveness and safety of operative laparoscopy (OL) when used for the treatment of ectopic pregnancy in the setting of a residency training program. STUDY DESIGN: We retrospectively reviewed records of all patients with diagnostic laparoscopy documenting the presence of an ectopic pregnancy. Patients who met the following criteria were selected: hemodynamic stability, tubal distortion no greater than 5 cm and adequate visualization of the pelvis. The cases performed via OL were compared to the cases performed via laparotomy (LAP). All the surgery had been performed by resident physicians with the attending gynecologist as first assistant/supervisor. RESULTS: Ninety-five cases performed from March 1989 to April 1992 met the above criteria. Group 1 consisted of 61 patients treated with LAP. Group 2 consisted of 34 patients treated with OL. The operating time (76.8 +/- 19.0 vs 76.0 +/- 23.0 min, mean +/- SD) and the estimated blood loss (275.0 +/- 183.7 vs. 70.5 +/- 75.2 ml) were similar for both groups. The hospital stay for the LAP group was longer than for the OL group (3.7 +/- 1.2 vs. 1.4 +/- 0.6 days, P < .001). The surgical complication rate was also higher in the LAP group (23% vs 2.9%, P = .16). CONCLUSION: In our residency program the introduction of OL for the management of ectopic pregnancy has resulted in shorter hospital stays and lower morbidity without increased duration of the surgical episode or increased blood loss.

Blood Loss, Surgical↗
PubMed1996

Pregnancy after failed tubal sterilization.

OBJECTIVE: To review the pregnancy outcome in patients with failed tubal sterilization treated in our hospital and to compare the incidence of ectopic pregnancy in our study group with the experience at other military hospitals and with the incidence of ectopic pregnancy in similar patients reported in the literature. STUDY DESIGN: A registry of failed tubal sterilization was started at our hospital in 1989. We entered all information regarding the type of procedure and pregnancy outcome as the patients presented for care. Information on the experience at other military hospitals was obtained through review of data provided by the epidemiology section of the Health Services Command, San Antonio, Texas. RESULTS: From 1989 to 1991, 12 patients with failed tubal sterilization received care at our hospital. Eight patients (67%) had ectopic pregnancies. Of 137 patients identified through the Health Services Command, 49 (36%) had ectopic pregnancies. CONCLUSION: The literature reports a 5-90% incidence of ectopic pregnancy after failed tubal sterilization. The data from our registry and from the Health Services Command corroborate the increased likelihood of ectopic pregnancy in patients with failed tubal sterilization and underscore the need for close follow-up of these patients until the location of the pregnancy is documented.

Adult↗