Biomedical subjects
Publications and source records attributed to C Valero.
Endocarditis due to Acinetobacter is a rare pathology with high mortality, reported mainly in hospitalized patients with predisposing risk factors. This is the second case of endocarditis due to Acinetobacter reported in our country in the last 10 years.
OBJECTIVE: To find the chronic prescription of medication in older people, associated variables and its quality. DESIGN: Observation, descriptive-crossover study. SETTING: Urban health district. PATIENTS: Sample stratified in age and sex groups of 385 people of 65 and over registered at the health centre and not in institutions. MEASUREMENTS AND MAIN RESULTS: Social and demographic data, self-perception of health and functional capacity were obtained through interview; and pathology and medication records, from the clinical records and authorized medication cards. 349 people, average age 73 (SD +/- 6.5), were interviewed. There were 210 women and 139 men. 12% perceived their health as bad/very bad. Barthel's index and the Lawton scale were disturbed in 13.8% and 30.4%, respectively. 93% suffered some chronic pathology (average 2.7). 81.4% habitually took medication (average 3.1). The most commonly consumed drugs belonged to the cardiovascular (32%), nervous system (21%) and digestive apparatus and metabolism (17%) groups. For the first group, the main drugs were ACEIs and diuretics; for the second, analgesics and neuroleptics; for the third, antacid and antiulcer drugs. 86% had high intrinsic value, the most prescribed drugs of those with low intrinsic value belonged to the antivaricose, cerebral and peripheral vasotherapy, and urological drugs groups. Multiple medications was related significantly to having more than two chronic pathologies (OR = 7.89, 95% CI 4.40-14.15) and self-perception of worse health (OR = 2.51, 95% CI 1.13-5.59). CONCLUSION: The elderly persons with a greater number of pathologies and perception of worse health took more medication. We thought that our quality of prescription was acceptable, although we should review the indications for neuroleptics and reduce prescription for medication of low therapeutic value.
Explore the source record for details and available documents.
BACKGROUND AND PURPOSE: We investigated circadian rhythm in ischemic stroke onset and its subtypes, differentiating between first-ever stroke and recurrent stroke. METHODS: A consecutive series of 1223 patients with ischemic stroke was admitted at 2 reference hospitals; the time of onset of symptoms was obtained, differentiating between onset while asleep and awake. We compared circadian rhythm between stroke types and between first-ever and recurrent stroke. RESULTS: The onset time was known in 914 patients; 25.6% experienced onset on awakening [higher incidence in thrombotic and lacunar stroke (28.9% and 28.4%, respectively) than in embolic stroke (18.8%)]. For all stroke subtypes, there was a significant diurnal variation, with a morning peak between 6 AM and noon; after redistributing the hour of onset of patients awakening with stroke, the morning peak was minimal in all types of stroke. There were no differences in circadian rhythm between patients with first-ever and recurrent stroke. CONCLUSIONS: Only hospitalized patients were studied. There is a circadian rhythm in all types of stroke, with higher frequency during the day and lower frequency in the last hours in the evening. The highest incidence in the early hours of the morning can be overestimated, due to patients who awaken with stroke. There is no difference in circadian rhythm between first-ever stroke and recurrent stroke.
The cerebral cortex of eight patients with complicated head and brain traumatic injuries has been examined with light and transmission electron microscopes. The neuronal and neuroglial cell bodies and their processes have been examined to study the changes induced by the brain injury and the associated vasogenic and cytotoxic, moderate or severe, brain oedema. Light microscopy study showed oedematous and ischaemic neurons and neuroglial cells in both moderate and severe oedema, and breakdown of the blood-brain barrier with perivascular and parenchymatous haemorrhagic foci. Astrocytes and oligodendrocytes exhibited oedematous and reactive changes. At the electron microscope level oedematous changes were found in intraneuronal and glial somatic compartment. Myelinated axons showed clear and dark degenerative features. Beaded dendrites and clear and dense synaptic degeneration were also found. The extracellular space appeared distended, with the presence of clear and electron-dense haematogenous oedema fluid and fibrinous organization. Phagocytosis of degenerated myelinated axons and synaptic endings by neuroglial cells and non-nervous invading cells were observed. The clinical evolution time of traumatic brain injuries was considered in relation to nerve cell degenerative features.
OBJECTIVE: To study demographic and health related variables included in the municipal birth registry. Differences among municipal districts are assessed, as an approach to the study of inequalities in pregnancy, in birth and in its care. DESIGN: Observational study, based on secondary utilization of vital statistics data. SITE: The city of Barcelona (Catalonia, Spain), for the 1990-1991 years. PARTICIPANTS: Births from women who are city residents. MAIN RESULTS: Births concentrate around maternal ages of 25-29 years and 30-34. Adolescent mothers (less than 20 years) represent only a proportion of 1.9% of all births, and births from women above 34 years 13.7%, although only 2.1% of all births are from mothers above 40 years of age. Low birth weight (less than 2,500 g) occurs in 5.6% of all births. Preterm births (less than 37 weeks) occur in 4.7% of all deliveries. Teen age fertility, births to women above 34 years, low birth weight and preterm deliveries are compared across districts. Overall, four out of ten women use a public hospital for delivery, but this varies greatly among districts. There is no information on the father for 1.6% of all births. CONCLUSIONS: The completeness of this information source is high and the municipal registry is a useful database for the analysis of inequalities in small areas, using health related indicators which have higher frequency than more traditional indicators based on rare events (such as infant mortality). Differences among areas are found, related to life conditions and to prenatal and birth care.
Explore the source record for details and available documents.
Spinal muscular atrophy is an autosomal recessive disorder which affects about 1 in 10,000 individuals. The three clinical forms of SMA were mapped to the 5q13 region. Three candidate genes have been isolated and shown to be deleted in SMA patients: the Survival Motor Neuron gene (SMN), the Neuronal Apoptosis Inhibitory Protein gene (NAIP) and the XS2G3 cDNA. In this report we present the molecular analysis of the SMN exons 7 and 8 and NAIP exon 5 in 65 Spanish SMA families. NAIP was mostly deleted in type I patients (67.9%) and SMN was deleted in 92.3% of patients with severe and milder forms. Most patients who lacked the NAIP gene also lacked the SMN gene, but we identified one type II patient deleted for NAIP exon 5 but not for SMN exons 7 and 8. Two other patients carried deletions of NAIP exon 5 and SMN exon 7 but retained the SMN exon 8. Three polymorphic variants from the SMN gene, showing changes on the sequence of the centromeric (cBCD541) and telomeric copies of the SMN gene, were found. In addition, we show several genetic rearrangements of the telomeric SMN gene, which include duplication of this gene in one normal chromosome, and putative gene conversion events in affected and normal chromosomes. Altogether these results corroborate the high genetic variability of the SMA region. Finally, we have determined the ratio between the number of centromeric and telomeric copies of the SMN gene in parents of SMA patients, showing that the majority of parents of types II and III patients carried three or more copies of the cBCD541 gene; we suggest a relationship between the number of copies of cBCD541 and the disease phenotype.
A locus responsible for autosomal recessive spinal muscular atrophy (SMA) on chromosome 5q11.2-q13.3 has been mapped to a critical interval delimited by markers D5S435 and D5S557. By a modification of the Vectorette-(GT)n method, we have isolated three polymorphic CA repeats from two YACs of the SMA region. Two of them (D5S1417 and D5S1416) map within the SMA critical region, and the other (D5S1415) is centromeric to D5S435. Linkage analysis in Spanish SMA families with eleven markers showed that in our families the disease is linked to this region and confirmed that the novel markers are tightly linked to the SMA locus. The most likely order of markers was 5cen-(D5S63/D5S1356)-(D5S125/D5S465)- (D5S435/D5S1417/D5S1416/D5S557)-D5S610- D5S112-D5S127-5qter, with odds against alternative orders > 1,000:1. Genetic distances are in agreement with those previously published. However, the recombination fraction between D5S610 and D5S112 is remarkably greater than expected from the physical distance, suggesting a hot spot for recombination in this region. Our results from haplotype and multipoint analyses show that the SMA locus must lie between D5S465 and D5S112, and lend further support to the current location of the SMA locus.
Two samples of cerebral cortex of patients with clinical diagnosis of Arnold-Chiari type II malformation were studied with conventional transmission electron microscopy. Pyramidal and non-pyramidal nerve cells of layers II to V exhibited moderate and severe swelling of intraneuronal compartment. The cerebral cortex neuropile showed hydrocephalic edema featured by remarkable enlargement of the extracellular space, degenerated synaptic contacts and swollen dendrites. Interfascicular oligodendrocytes appeared extremely swollen with widened nuclear pores, apparent nucleo-cytoplasmic transfer of chromatinic substance and areas of focal necrosis. Swollen astrocytes displayed lamellar bodies, microfilaments and monogranular glycogen granules. The vacuolated astrocytes showed images suggestive of hydrocephalic edema resolution characterized by deep invaginations of the plasma membrane and formation of numerous cytoplasmic vacuoles. The cortical capillaries exhibited signs of increased cerebrovascular permeability, such as augmented endothelial vacuolar transport, open endothelial junctions and nodular thickening, thinnings and discontinuities of the basement membrane. A transparenchymal route for cerebrospinal fluid absorption through the cortical capillaries, as a means of hydrocephalic edema resolution, is proposed.
The cerebral cortex of 9 patients with complicated brain trauma has been examined with the transmission electron microscope to study the distinctive degenerative synaptic changes induced by brain injury and associated vasogenic, moderate or severe, brain edema. The brain injury and the hematogenous edema fluid accumulated in the dilated extracellular space of cerebral cortex neuropil induced swelling and shrinkage of pre- and postsynaptic structures, increased amount of presynaptic axoplasmic granular substance and clumping, enlargement and depletion of synaptic vesicles. In severe brain edema, swollen and shrunken presynaptic endings with discontinuous limiting plasma appeared separated from the postsynaptic structures and detached from glial ensheathment (synaptic disassembly). Post-synaptic shaft dendrites and their spines showed swelling and vacuolization. Fragmen-tation and atrophic changes of spine apparatus were found in the dendritic spines. The clear and dark types of degeneration were observed in most cases examined, in both preand/or postsynaptic structures. Filamentous hypertrophy of presynaptic endings was observed only in two cases. Osmiophylic bodies, necrotic membranes, lipid inclusions and glycogen granules were seen in the synaptic terminals. Disappearance of synaptic densities was evident in some cases. Phagocytosis of isolated presynaptic endings or of the entire synaptic contacts by astrocytes, microglial cells and by non-nervous invading cells, such as monocytes and macrophages, was found.
The present paper shows the potential contribution of conventional and high resolution scanning electron microscopy (SEM) to trace short intracortical circuits in cryofractured fish, primate and human cerebelli. Conventional SEM slicing technique allowed us to identify afferent mossy and climbing fibers and their synaptic relationship in the granular layer. SEM freeze-fracture method exposed the mossy glomerular synapses and the axo-dendritic connections of climbing fibers. At the Purkinje cell layer, the cryofracture process removed the satellite Bergmann glial cell layer, displaying a partial view of the supra- and infra-ganglionic plexuses of Purkinje cells and the ascending pathways of climbing fibers. High resolution SEM (HRSEM) showed the specimen specific secondary electron (SE-I) image of axosomatic synapses on Golgi cell surface. At the molecular layer, the outer surface of parallel fiber synaptic varicosities were distinguished, establishing the cruciform en passant synaptic contact with the Purkinje cell dendritic spines. HRSEM showed the fractured parallel fiber synaptic varicosities containing spheroidal synaptic vesicles embedded in a high dense extravesicular material. Conventional SEM and gold-palladium coating are useful to trace intracortical circuits. With HRSEM and chromium coating, it is possible to study the outer and inner surfaces of synaptic connections.
Cortical biopsies of 17 patients with clinical diagnosis of hydrocephalus and associated pathology were examined in the transmission electron microscope. Moderately and severely edematous neurons showed relevant structural changes of the Golgi apparatus consisting of either discrete or marked dilation, fragmentation, and partial disappearance of Golgi stacked cisternae. In Arnold-Chiari malformation small Golgi complexes of vesicular type and atrophic changes were observed in severely edematous neurons. The microtubules appeared intact, suggesting differential response between Golgi complex and microtubules. Atrophic changes of the Golgi complex coexisted with degenerated presynaptic endings.
OBJECTIVE: To analyse for the 1987-1990 period the indicators of prenatal care and the social-health follow-up of adolescent girls included in the mother-child programme of Ciutat Vella (Barcelona). This programme was aimed at pregnant women resident in the district and with high social risk profiles. DESIGN: Descriptive and retrospective study. MEASUREMENTS AND MAIN RESULTS: 175 adolescent mothers were included in the programme during the period under study. This represented 82.9% coverage of all births in the district to this age group. In 10.9% of cases the mother stated she lived alone. 10.2% had had a previous child. There were drug addiction antecedents in 5% of the mothers. The first prenatal check took place during the first three months only in 56% of the pregnancies, with the proportion of low weight births (LWB: weight at birth below 2,500 grams) at 13.1%. During the period under study the proportion of pregnant women checked in the first three months went up from 45.6% to 62.5%, while the proportion of LWB's went down from 19.3% to 6.3%. CONCLUSIONS: There has been both a striking improvement in the indicators of prenatal care and less low weight births during the first four years of this programme. It is worth noting the worrying fact that one third of pregnant adolescents do not attend for a prenatal check-up before three months of their pregnancy have elapsed.
This paper describes the distribution of fertility and abortion rates in the city of Barcelona (Spain) in adolescent in 1990. The adolescents' socio-demographic background and characteristics of their family unit obtained from the statistically bulletin of birth are analyzed. In this year, there were 248 births and 195 abortions to women between 15 and 19 years-old, yielding a rate of 3.9 and 3.1 per thousand, respectively, so that at least 7 per 1000 were pregnant. Fertility rates varied by district between 0.8 in Sarrià-Sant Gervasi and 14.6 in the inner city district of Ciutat Vella, with a high positive correlation of these rates and a district social problem index (r = 0.96) and a high negative correlation with an index of family economic wealth (r = 0.93). Around two thirds (63%) of the adolescent mothers reported to be living with their parents after childbirth, and their companion joins this unit in four out of ten cases. In 14.5% of births, the father's age under 20, although the most of them (39.1%) were between 20 and 24 years-old. Although teenage fertility rates have been declining during the last years in Barcelona, the strong correlation with socio-economic indicators encourages the design of specific programs addressing socially disadvantaged groups. In addition, several risk factors can be used to identify adolescent mothers at risk when designing specific interventions such as the lack of recognized paternity by the father, dropping out of school, or lacking family's support.
INTRODUCTION: Progressive supranuclear palsy is a neurodegenerative disorder affecting diverse neurologic systems. The actual treatment response is poor in most patients. OBJECTIVE: review of a long series of patients affected by PSP in several aspects. PATIENTS AND METHODS: A series of patients was reviewed by means of the register questionnaire of PSP in Spain (from PSP Disabling Rating Scale and Staging System). This is carried out on the patients when the diagnostic is done. It was achieved a descriptive of the patients, in several aspects, and an evaluation of the treatment in relation to the dose and the duration. RESULTS: In general, the age of diagnostic is 66 years, there is not neurological illness in the family, falls and disorders of gait are the most representative parameters. The neuroimage shows fronto temporal atrophy. The treatment response is poor, despite the dose and the duration. CONCLUSIONS: Our series confirms the typical dates of the illness an the poor response to treatment with L Dopa.
INTRODUCTION: Hemifacial spasms consist in tonic clonic, involuntary, asymmetrical and asynchronous contractions in the territory innerved by the facial nerve. Several different causes may give rise to this disorder, the most frequent of which are vascular abnormalities in the cerebellopontine angle. Its clinical features and electrophysiological studies are commonly used in diagnosis and its etiological diagnosis is most frequently performed by means of magnetic resonance imaging. Symptoms are treated using local injections of Botulinum toxin Type A in the affected muscles. AIMS: To review our experience in the handling of this pathological condition and to determine the results of employing Botulinum toxin. PATIENTS AND METHODS: We describe the cases of bilateral hemifacial spasms that have been diagnosed in the Virgen Macarena Hospital in Seville and La Fe in Valencia since 1980, as well as the follow up after treatment with Botulinum toxin. RESULTS: We describe eight cases of this pathological condition in which patients were treated with Botulinum toxin, and in all cases there was an improvement in the symptoms. CONCLUSIONS: Treatment with Botulinum toxin is considered to be satisfactory and provides a marked improvement in the patients quality of life.
INTRODUCTION: Plexiform neurofibroma in any location is one of the commonest complications associated with neurofibromatosis type 1 (NF1). Plexiform neurofibroma of the upper eyelid and orbit is usually associated with ipsilateral hemifacial hyperplasia. We present four patients with NF1 and plexiform neurofibroma of the eyelid and orbit associated with hemifacial hyperplasia, who also showed hyperplasia of the unilateral cerebral hemisphere. CASE REPORTS: There are four patients, three females and one male, who consulted because of NF1 with plexiform neurofibroma of upper eyelid and hemifacial hyperplasia. Upper eyelid involvement was observed since birth and progressed during the first years of life. The patients showed normal neurological and mental development without motor or cerebellar disorders. Magnetic resonance studies demonstrated the asymmetric hyperplasia of the ipsilateral hemisphere in all four cases and of the cerebellar hemisphere in one case. The degree of hemispheric hyperplasia was related to the size and extension of the plexiform neurofibroma, as well as to the severity of the hemifacial hyperplasia. In our case which had the plexiform neurofibroma extended to the neck and the upper thorax, the hyperplasia not only affected the cerebral hemisphere but also the ipsilateral cerebellar hemisphere. All parts of the hemisphere showed increased size. The cortex of the entire hemisphere showed normal differentiation of the subcortical white matter. CONCLUSION: NF1 appears to be related with facial and cerebral ipsilateral hemihyperplasia. The relation between the size and extension of the orbital, eyelid and facial plexiform neurofibroma and the degree of asymmetry of the hemispheric hyperplasia suggest that different influences of a still unknown agent, possibly a gene, obviously related to NF1, causes both the intracranial and extracranial abnormalities.