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Biomedical subjects

D Guerrero

Publications and source records attributed to D Guerrero.

At least 37 records · Page 2Linked to original sources
PubMed1995

Modifying the Barthel Performance Index Score for use in patients with brain tumours.

Performance status scores are useful tools in the management of patients with malignant disease. No specific performance index score exist, however, for patients with glioma. The Barthel Index, has been used in our department because it has been widely used in patients following stroke and found useful. This study aims to establish whether a modification of the Barthel Index would be more appropriate for patients with glioma and, if so, what modifications should be made. The opinions of multidisciplinary health workers and carers experienced in helping patients with glioma were established by questionnaire. Difficulty with speech and the presence of seizures were statistically ranked the most significant disability in terms of overall performance status. As these are not included in the Barthel Index a modification is justified. However, to include new categories in a performance index but avoid increasing its complexity, existing categories have to be omitted. Therefore, the second aim of this study was to establish which categories within the Barthel contribute least to a change in the total score. Three-hundred-and-thirty-three prospectively recorded Barthel scores were evaluated in 81 patients over 2 years and the individual categories evaluated by multifactor analysis. The sensitivity of the categories 'bowel function' and 'independence in grooming' to a change in the total score was less than 1%. In conclusion, substituting 'speech difficulties' and the presence of seizure in place of 'bowel function' and 'independence in grooming' from the Barthel Index will improve the specificity for patients with glioma without reducing the sensitivity or acceptability for the patients and research nurses who most often complete them.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed1995

Pulmonary arteriovenous fistula ruptured to pleural cavity in pregnancy.

Congenital pulmonary arteriovenous fistula is frequently associated with hereditary haemorrhagic telangiectasia (Rendu-Osler-Weber disease). With the increased blood flow in pregnancy such fistulas enlarge, occasionally giving rise to haemothorax, which generally has a poor prognosis. A familial case is presented in which massive haemothorax required emergency thoracotomy in the 27th week of pregnancy.

Adult↗
PubMed1994

Use of antithrombin III in critical patients.

OBJECTIVE: To evaluate the effect of the AT III concentrates upon the clinical evolution and hemostatic parameters. DESIGN: Prospective, open, randomized trial. PATIENTS AND PARTICIPANTS: Septic and multiple trauma patients admitted to our Intensive Care Unit. SETTING: Levels of AT III below 70% were used as criteria to choose 36 patients, 20 of whom received treatment with AT III and 16 did not. INTERVENTIONS: AT III concentrates were administered at an initial dose of 60 U/kg followed by 10 U/kg every six hours. RESULTS: The administration of AT III neither contributes to alterations in haemostasis, nor the clinical evolution (evaluated according to Apache II score). CONCLUSIONS: The results suggest that the administration of AT III concentrates to critical patients with acquired low levels, but without manifest DIC, may not be justified; although further studies on a larger population are required to establish definite conclusions.

APACHE↗
PubMed1994

Hypofractionated radiotherapy as palliative treatment in poor prognosis patients with high grade glioma.

We report the palliative effectiveness of a hypofractionated radiotherapy regimen in patients with poor prognosis high grade glioma. Thirty-eight elderly, and/or disabled patients received radiotherapy to a dose of 30 Gy in 6 fractions over 2 weeks to a planning target volume defined by the enhancing tumour and a 2-cm margin. The median survival was 6 months with a 1-year survival rate of 23%. Treatment was without acute toxicity. One month after radiotherapy, functional status, assessed using a verbally administered Barthel index, improved in 38% and remained stable in a further 39% of surviving patients. At 3 months 39% of surviving patients had improved and a further 12% remained stable. We conclude that in the poor prognostic group of patients with high grade glioma hypofractionated partial brain radiotherapy is well tolerated, convenient and provides effective palliation in a proportion of patients. Comparison with conventional radiotherapy or symptomatic care alone require further evaluation in randomised studies.

Activities of Daily Living↗
PubMed1994

Who should follow up cancer patients? Nurse specialist based outpatient care and the introduction of a phone clinic system.

The objective of this study was to pilot and evaluate a nurse based follow-up system for oncology patients in terms of feasibility and impact on outpatient oncology practice. We identified clinical situations with a defined range of clinical problems, which were set out on a proforma (Appendix) for a nurse consultation. Following a period of training, surveillance during radiotherapy was transferred to a nurse 'on treatment clinic' and a defined point of post-treatment follow-up to a nurse 'phone clinic'. The effectiveness of the nurse based follow-up was assessed by a prospective analysis of the consultation records. The impact on clinical practice was assessed in the form of audit of the clinic work-load before and after introduction of the nurse follow-up service. The patient assessment by the nurse specialist was satisfactory and covered the range of problems encountered. Medical referral by the nurse specialist was necessary in 3/33 on treatment assessments and 1/61 phone appointments. The medical outpatient work-load was estimated to decrease by 30%. Structured follow-up by a skilled and trained nurse specialist provides excellent support and effective medical surveillance in defined situations in oncology follow-up. Patients appeared satisfied with the arrangement and the pilot study suggested up to 30% reduction in the medical outpatient work-load. The use of 'phone clinics' offers an effective alternative to the conventional outpatient clinic model, while being less costly and more convenient for patients and staff.

Ambulatory Care Facilities↗
PubMed1993

Gaps in cardiovascular medication taking: the tip of the iceberg.

OBJECTIVE: To search for major gaps in medication-taking behavior predisposing patients to cardiovascular morbidity and mortality. DESIGN: Convenience sample; cohort prospectively followed for < or = 5 months. SETTING: General internal medicine and cardiology clinics in a university medical center. PATIENTS: From among 893 patients, the authors identified 132 eligible individuals and entered 33 subjects (25%) with chronic cardiovascular conditions, 1-3 chronic oral medications for these conditions, overall regimen of < or = 6 drugs, regular visits at 1-3-month intervals, literacy in English, willingness to use electronic monitors, and physician permission to participate. OUTCOME MEASURES: Medication compliance rates and patterns by patient self-report, physician estimates, pill count, and electronic monitoring of pill vial opening. RESULTS: Despite moderately complex regimens (5.4 +/- 0.5 pills daily; range 1-11), most subjects took most medications according to the prescription: median intervals between pill vial openings were 1.00, 0.50, and 0.43 days for once, twice, and three times daily dosing, respectively. Medication-taking gaps of > or = 2 times the prescribed interdosing interval occurred for 48% of the patients. Patients' dosing patterns often produced "uncovered" intervals (mean duration 3.7 days, range 0-25) with doubtful pharmacologic effectiveness. These lapses were underestimated by patients and poorly perceived by their treating physicians, despite familiarity with their care. Baseline sociodemographic, psychosocial, medical system, or clinical characteristics did not predict the patterns or degrees of medication noncompliance. CONCLUSIONS: Major treatment gaps occur frequently, even in carefully selected ambulatory populations, and generally escape detection. The compliance patterns and gaps may contribute to reported excesses of cardiovascular morbidity and mortality.

Adult↗
PubMed1993

Antihypertensive medication-taking. Investigation of a simple regimen.

In search of strategies to improve compliance, we assessed medication-taking behavior among 19 ambulatory hypertensives, using both pill counts and electronic monitoring. The regimen consisted of one pill each day for < or = 63 weeks with return visits at 1 to 4 week intervals. The study population was 79% male, 68% white, and 16% black with mean (+/- SEM) age 58.4 +/- 2.5 years. Only 51% of the intervisit intervals displayed > or = 80% of vial openings within the desirable range (24 +/- 6 h). Pill counts detected only 2% of suboptimal interdosing intervals identified by electronic monitoring. Early changes in compliance correlated well with later changes (r = 0.83, P = .002). A few of the subjects exhibited a large deviation from the prescription, uncorrectable with drugs having a long duration of action. We conclude that (a) pill counts tend to overestimate patients' compliance rates; (b) changes in medication-taking behavior early in therapy may predict subsequent compliance rates; and (c) prolonging drug action may compensate for some imperfect medication-taking behavior.

Adult↗
PubMed1983

Nature of interaction of different wild type Vibrio cholerae with intestinal mucosa.

Scanning electron microscopy (SEM) was used in this study to investigate the mechanism of association of cholera vibrios with the intestinal mucosa. For this purpose, the interactions of three virulent, wild type strains (CA401, P, and 3083) of Vibrio cholerae with intestinal segments of infant mice were compared. The results of previous studies by different investigators using the three strains separately and in different assay systems had led to differing conclusions concerning the mechanisms of association with the mucosa. In this study, observations by SEM of the infant mouse intestinal segments, previously incubated in suspensions of the organisms, revealed that all three strains preferentially associated with intestinal mucin. The vibrios associated poorly with the mucosal epithelial surface even in areas of the segments free of mucin or in segments washed to remove mucin prior to the assay. In each case, the vibrios associated better with the serosal surface than with the epithelial surface of the mucosa, but not to the degree that they associated with mucin on the mucosal surface. The major difference observed by SEM of the strains was the markedly greater association of strain 3083 with the serosal surface as compared to strains CA401 and P.

Animals↗
PubMed1981

Association of Vibrio cholerae mutants with the intestinal mucosa of infant mice.

Scanning electron microscopy (SEM) was used to observe the nature of association of mutant strains of Vibrio cholerae to infant mouse intestinal segments. Parental strain Inaba CA 401 was compared to the following mutant phenotypes: nonchemotactic, nonchemotactic reduced motility, flagellated nonmotile, nonflagellated nonmotile, and mucin nonutilizing. The virulence of the different strains was determined by oral-intra-gastric inoculation of seven-day-old mice. Localization of the parental strain during the course of infection in the patent gut of infant mice was followed by the fluorescent antibody (FA) technique. The highly virulent parental strain rapidly penetrated intervillus spaces in the upper and lower regions of the small intestine. By SEM the organism also associated markedly with the mucosal surface of intestinal segments. However, the vibrios were associated predominately with the intestinal mucin rather than the epithelial cell surfaces of villi. Nonchemotactic vibrios retained full virulence and ability to associate with the mucosa. The nonchemotactic strain with a reduced rate of motility was partially deficient in these properties. Nonmotile vibrios of either type were markedly reduced in both properties. The mucin nonutilizing strain associated normally but was weakly virulent. Low virulence of this strain may be due to a reduced ability of the organisms to multiply in the mucin.

Animals↗
PubMedDate not supplied

[Prevalence of CYPD6 mutations in sporadic Parkinson's disease: case-control study].

Genetic factors seem to play an important role in the development of Parkinson's disease. The degeneration of the sustantia nigra, characteristic of this disease, might be due to the toxic effect of substances derived from cellular metabolism. The CYP2D6 gene codifies for the metabolising enzyme debrisoquie-4-hydroxilase involved in the detoxification of part of these products. The presence of determinate mutations in the gene implies a lack of enzymatic activity and generates the "poor metaboliser" phenotype. By means of the PCR-RFLP technique, the presence of the genetic mutations CYP2D6 3, CYP2D6 4, CYP2D6 6 and CYP2D6 8 has been analysed in a group of 46 patients with PD and in 54 controls, with the aim of studying the possible value of genotype CYP2D6 as a risk factor for Parkinson's disease in the population of Navarra. The alleles CYP2D6 3, 6 and 8 are not represented in the sample studied. We have not obtained a greater presence of CYP2D6 4 mutations in the patients with respect to the controls (30.43% vs. 44.44%). There is no correlation between Parkinson's disease and the presence of CYP2D6 4 mutations (odds ratio 0.55; 95% CI 0.24 to 1.25), in homozygosis (odds ratio 0.38; 95% CI 0.04 to 3.76) or in heterozygosis (odds ratio 0.62; 95% CI 0.27 to 1.44). In conclusion, the genotype CYP2D6 does not constitute a risk factor in PD.

English Abstract↗
PubMedDate not supplied

A nurse-led service.

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Central Nervous System Neoplasms↗
PubMedDate not supplied

Brain tumours.

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Brain Neoplasms↗
PubMedDate not supplied

[Case-control study of markers of oxidative stress and metabolism of blood iron in Parkinson's disease].

BACKGROUND: Increasingly growing evidence exists of the involvement of oxidative stress mechanisms in Parkinson's disease. Lower levels of GSH in the sustantia nigra, an increase in iron buildup, an increase in the byproducts of lipid peroxidation and alterations in the mitochondrial complex I have been described. However, few studies have been made of levels of antioxidants in the peripheral bloodstream and of the influence of the intake of nutrients on the development of this disease. METHODS: In a group of 79 patients afflicted with idiopathic Parkinson's disease and a control group comprised of 107 subjects, compared by age, sex and place of residence, the lowered levels in the plasma of glutathione (GSH), malon dialdehyde (MDA), uric acid, tocophenol, beta-carotene, lycopene and different iron metabolism parameters were studied. Likewise, the intake of certain antioxidants was estimated based on a dietary survey. RESULTS: Significant differences (p < or = 0.001) were found in the plasma levels of GSH between cases (0.10 mumol/ml +/- 0.06) and controls (0.29 mumol/ml +/- 0.12). Likewise, the plasma levels of uric acid were lower (p < or = 0.05) in the cases (4.96 mg/ml +/- 1.96) than in the control groups (5.39 mg/ml +/- 1.13). No significant difference was found in the plasma levels of MDA, tocopherol, beta-carotene and lycopene. With regard to iron metabolism, significantly higher ferritine and transferrin values were found in the patients with EP than in the control group, showing a lower transferrin saturation percentage (p < or = 0.05). The iron showed no significant changes between cases and control groups. CONCLUSIONS: The results of this study support the possible involvement of oxidative stress in the pathogenesis of Parkinson's disease and reveal, in turn, alterations in some peripheral blood parameters in keeping with known findings in the sustantia nigra.

Aged↗
PubMedDate not supplied

[Guidelines for the clinical management of neuropathic pain (II)].

INTRODUCTION: Up to 5% of the population suffers from neuropathic pain (NP). A bibliographical search in several databases revealed that, to date, there are no protocols to guide physicians who are not specialists in pain that enable them to treat NP and thus improve patients' quality of life. AIMS: The aim of this study is to provide Spanish-speaking physicians who are not specialists in pain with a set of guidelines for the treatment of NP. A bibliographical search was performed in order to base the results and conclusions on the evidence-based medicine methodology. DEVELOPMENT: First, we review the most effective clinical and paraclinical methods for diagnosing NP, and the LANSS pain scale is reported as the most appropriate method of clinically evaluating NP. The anatomical paths and the physiology of pain are then described and we review the molecular variables involved. Finally, we point out the current therapeutic options and propose an algorithm for the treatment of NP. CONCLUSIONS: There is no specific set of guidelines for the treatment of NP. At the present time, the keystone of NP treatment consists in the use of antidepressant and anticonvulsive drugs. There is a need for further clinical trials to prove the effectiveness of using combined medication.

Decision Trees↗