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Biomedical subjects

Carlos A Estrada

Publications and source records attributed to Carlos A Estrada.

9 recordsLinked to original sources
PubMed2006

CC chemokine receptor (CCR)-2 prevents arthritis development following infection by Mycobacterium avium.

The host factors that influence autoimmune arthritides such as rheumatoid arthritis have not been fully elucidated. We previously found that genetic inactivation of CC chemokine receptor 2 (CCR2) in the arthritis-prone DBA/1j mouse strain significantly increases the susceptibility of this strain to autoimmune arthritis induced by immunization with collagen type II (CII) and complete Freund's adjuvant (CFA). Here, we show that following intradermal infection with Mycobacterium avium, a similar arthritis phenotype was detected in Ccr2-null mice in the DBA/1j, but not in the BALB/c background. The failure to develop arthritis in Ccr2-null BALB/c mice occurred in the face of high bacterial burdens and low interferon gamma (IFNgamma) production. By contrast, Ccr2-null DBA/1j mice had low bacterial burdens, produced normal amounts of IFNgamma, and had high titers of autoantibodies against CII. Thus, the Ccr2-null state in an arthritic-prone genetic background leads to increased arthritis susceptibility following infectious (M. avium) and noninfectious (CII/CFA) challenges. Because CCR2 serves as a negative regulator of murine arthritis, caution might need to be exercised while testing CCR2 blockers in human arthritis or other diseases. These findings also indicate that Ccr2-null DBA/1j mice might serve as a valuable model system to uncover the immunological determinants of arthritis and to test novel antiarthritic agents.

Animals↗
PubMed2006

Outpatient management of cirrhosis: a narrative review.

Cirrhosis is the 12th leading cause of death in the United States. Individuals with cirrhosis are at risk for many potential complications. Complications can be managed or detected early with proper outpatient management. The most lethal of these complications is bleeding esophageal varices. All patients with cirrhosis should be screened for the presence of varices and treated when indicated. The most common complication seen in these patients is ascites. Ascites can be treated with dietary modifications and a diuretic regimen. Other potential complications include spontaneous bacterial peritonitis, hepatocellular carcinoma, hepatic encephalopathy, hepatorenal syndrome, and hepatopulmonary syndrome. The outpatient management of these complications will be discussed in this paper, along with the use of vaccinations, educating patients about the avoidance of hepatotoxic drugs, and when to refer a patient for liver transplant.

Ambulatory Care↗
PubMed2005

The complex role of the chemokine receptor CCR2 in collagen-induced arthritis: implications for therapeutic targeting of CCR2 in rheumatoid arthritis.

CCR2 has been widely considered as a potential therapeutic target for autoimmune disease, particularly rheumatoid arthritis, and various CCR2 blocking agents have been developed, some of which have entered clinical trials. In this review, we examine the relevant information regarding the role of CCR2, and to a lesser extent of the closely related chemokine receptor CCR5, in the immunopathogenesis of collagen-induced arthritis, an animal model of rheumatoid arthritis. Experimental evidence showing that CIA is accelerated and exacerbated when CCR2 is genetically inactivated (knockout mice) or blocked with specific antibodies warrant additional investigations before the relevance of the findings in rodent models can be applied to human patients with RA.

Animals↗
PubMed2005

The 10-minute oral presentation: what should I focus on?

BACKGROUND: Little empirical evidence is available in the medical field defining the most important features of a scientific presentation. We sought to empirically identify what features of a scientific oral presentation experienced reviewers focus on when asked to identify the best features and areas to improve. METHODS: Observational study of 44 presenters at a scientific meeting over a 4-year period. Reviewers observed presenters and identified the best features and made suggestions for improvement using an open-ended form. We developed a coding form based on three domains: content, slides, and presentation style. Two raters blinded to the presenter then coded the comments, and disagreement was resolved by concurrent review. RESULTS: Reviewers made at least one comment about content in 42 (95.5%) of the presentations, about slides in 38 (86.4%), and about presentation style in 42 (95.5%). The most frequently extracted comments on best features of presentations in the domain "content" were identifying a key concept (43.2% of presentations) and relevance (43.2%). Similarly, best features in the domain regarding "slides" were clarity (50.0% of presentations), graphics (27.3%), and readability of the text and font size (22.7%). Finally, best features in the domain regarding "presentation style" were clarity (59.1% of presentations), pace (52.3%), voice (47.7%), engaging with the audience (43.2%), addressing questions (34.1%), and eye contact (22.7%). Various other comments were noted to improve presentations. CONCLUSIONS: Important features during oral presentations relate to specific areas of content, clear slides, and a presentation style that was well paced, engaging, and clear. Nonverbal communication is important in oral presentations.

Audiovisual Aids↗
PubMed2004

Literacy and numeracy skills and anticoagulation control.

BACKGROUND: The ability to use printed material to function in society (literacy) and to handle basic numerical concepts (numeracy) may have implications in patients' ability to follow dosing schedules. We examined literacy and numeracy skills among patients on warfarin and explored their association with anticoagulation control. METHODS AND RESULTS: Patients older than 50 years attending two anticoagulation management units were prospectively enrolled. We measured literacy, numeracy, and international normalized ratio (INR). During a 3-month follow-up period, we calculated the variability of the INR and the amount of time a patient's INR was within his or her therapeutic range, variables associated with bleeding and effectiveness. Among 143 patients, only 75 (52.4%) were able to read health-related words at the eighth grade level or less. Patients' self-reported grade completed was higher than the measured literacy grade level (kappa = 0.21). While 79.0% had completed at least eight grades, only 47.6% had a score at that grade level. Sixty-nine patients answered none or correctly answered fewer than two of the six numeracy questions (48.3%). The INR variability was higher among patients with lower literacy (P = 0.009) and lower numeracy skills (P = 0.004). The time in range was similar among patients at different literacy levels (P = 0.9). Patients with lower numeracy level spent more time above their therapeutic range (P = 0.04) and had a trend of less time spent in range (P = 0.10). CONCLUSIONS: Low literacy was prevalent among study patients taking warfarin. Low literacy and numeracy were associated with measures of poor anticoagulation control.

Aged↗
PubMed2003

Outcomes and perioperative hyperglycemia in patients with or without diabetes mellitus undergoing coronary artery bypass grafting.

BACKGROUND: The association between perioperative hyperglycemia and outcomes in patients with and without diabetes mellitus undergoing coronary artery bypass grafting is not well defined. We measured the association between perioperative hyperglycemia and outcomes among patients undergoing coronary artery bypass grafting. METHODS: We report a historic cohort study of 1574 patients who had undergone coronary artery bypass grafting between 1998 and 1999, 545 (34.6%) with diabetes. Perioperative blood glucose level was defined as the average of all blood glucose tests obtained on the day of and the day after surgery. Outcomes were 30-day mortality, infection rates (sternum, harvest site, sepsis, pneumonia, urinary tract), and resource utilization. RESULTS: After adjusting for diabetes status and calculated preoperative mortality or mediastinitis risk scores, each 50 mg/dL (2.78 mmol/L) blood glucose increase was not statistically associated with higher mortality (odds ratio 1.37; 95% confidence interval, 0.98 to 1.92; p = 0.07), or higher infection rate (odds ratio 1.23, 95% confidence interval 0.94 to 1.60; p = 0.14). Each 50 mg/dL blood glucose increase was associated with longer postoperative days by 0.76 days (95% confidence interval 0.36 to 1.17 days; p < 0.001), increased hospitalization charges by 2824 dollars (95% confidence interval 1599 dollars to 4049 dollars; p < 0.001), and increased hospitalization cost by 1769 dollars (95% confidence interval 928 dollars to 2610 dollars; p < 0.001). In the unadjusted analysis, infections occurred more frequently in patients with diabetes (6.6% vs 4.1%, p = 0.03). CONCLUSIONS: Perioperative hyperglycemia is associated with increased resource utilization in patients undergoing coronary artery bypass grafting with and without diabetes.

Blood Glucose↗
PubMed2003

Association of pancreatitis with administration of contrast medium and intravenous lipid emulsion in a patient with the acquired immunodeficiency syndrome.

Computed tomography is widely used to diagnose acute pancreatitis. Iodinated contrast medium lengthens the duration of pancreatitis and may increase the incidence of local or systemic complications. Total parenteral nutrition including IV lipid emulsion plays an important role in the management of patients with pancreatitis. Induction of pancreatitis by IV lipid emulsion is exceedingly rare. We report a 30-year-old patient with the acquired immunodeficiency syndrome in whom pancreatitis was exacerbated by oral and IV contrast medium and also by IV lipid emulsion in the absence of hypertriglyceridemia. Exclusion of the lipid emulsion resulted in prompt reduction of lipase levels on three separate occasions. This case is the first to implicate IV lipid emulsion in the exacerbation of pancreatitis in a patient with acquired immunodeficiency syndrome and normal baseline triglyceride levels. Thus, this case report suggests that we must exercise caution in the use of contrast medium and IV lipids in the diagnosis and management of acute pancreatitis.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Administrative data versus corrected administrative data.

The purpose of this research was to provide insight into the use of existing administrative data and to identify changes that could be made to improve broad-based use of administrative data. Data were collected on patients hospitalized with pneumonia at a 715 bed hospital in North Carolina in 1996-1997. Patients were selected from administrative databases via diagnosis and charge codes. Outcome variables were length of stay and total hospital charges. Explanatory variables were age, sex, race, insurance type, season of year, admission source (emergency department or other), comorbidity score, care path designation, physician specialty and teaching appointment. These data were collected from administrative data and then from a limited chart review to correct the administrative data. We found no significant differences in economic outcomes between the administrative data and the corrected administrative data. Administrative data appear to be a reliable and cost-effective data source for quality assessment.

Aged↗