Search PubMed⌕ Search

Biomedical subjects

F Escobar

Publications and source records attributed to F Escobar.

At least 19 recordsLinked to original sources
PubMed2001

White blood cell count and insulin resistance in patients with coronary artery disease.

White blood cell (WBC) count has been shown as a risk factor for cardiovascular disease. Decreased insulin sensitivity has been suggested as the link between these two entities. Our aim was to study the potential relation between insulin sensitivity and WBC count in patients with coronary artery disease. In order to assess insulin sensitivity, we performed 83 insulin suppression tests before and after therapy in 50 patients with coronary artery disease. Patients with glucose intolerance, arterial hypertension or obesity were excluded. Steady-state plasma glucose (SSPG) and insulin sensitivity index (ISI=1 000 x glucose infusion rate/SSPG) were considered as a measure of insulin sensitivity. WBC count, blood platelets, fibrinogen, microalbuminuria, creatinine, urea and HbA1c were also assessed. Simple and multiple correlation analysis were carried out between insulin sensitivity parameters and the other variables measured. There were significant correlation between SSPG and WBC count (r=0,32: p=0,003) and microalbuminuria (r=0,28: p=0,012). We also found statistically significant correlation between ISI and WBC count (r=0,27: p=0,015) and microalbuminuria (r=0,24: p=0,029). No correlation could be detected between either SSPG or ISI and the other variables measured. In multiple regression analysis, WBC count was found to be an independent predictor of both SSPG (p<0.01) and ISI (p<0.05). Our data show the existence of a significant relationship between decreased insulin sensitivity and WBC count in patients with coronary artery disease. The results of this study suggest that an elevated WBC count could be postulated as part of the insulin resistant syndrome.

Aged↗
PubMed1999

Cost-utility analysis of living-donor kidney transplantation followed by pancreas transplantation versus simultaneous pancreas-kidney transplantation.

For a type I diabetic with end-stage renal disease, the choice between a kidney-alone transplant from a living-donor (KA-LD) and a simultaneous pancreas kidney (SPK) transplant remains a difficult one. The prevailing practice seems to favor KA-LD over SPK, presumably due to the superior long-term renal graft survival in KA-LD and the elimination of the lengthy waiting time on the cadaver transplant list. In this study, two treatment options, KA-LD followed by pancreas-after-kidney (PAK) and SPK transplant, are compared using a cost-utility decision analysis model. The decision tree consisted of a choice between KA-LD + PAK and SPK. The analysis was based on a 5-yr model and the measures of outcome used in the model were cost, utility and cost-utility. The expected 5-yr cost was $277,638 for KA-LD + PAK and $288,466 for SPK. When adjusted for utilities, KA-LD + PAK at a cost of $153,911 was less cost-effective than SPK at a cost of $110,828 per quality-adjusted year. One-way sensitivity analyses were performed by varying patient and graft survival probabilities, utilities and cost. SPK remained the optimal strategy over KA-LD + PAK across all variations. Two-way sensitivity analysis showed that in order for KA-LD + PAK to be at least as cost-effective as SPK, 5-yr pancreas and patient survival rates following PAK would need to surpass 86 and 80%. In conclusion, according to the 5-yr cost-utility model presented in this study, KA-LD followed by PAK is less cost-effective than SPK as a treatment strategy for a type I diabetic with end-stage renal disease. For patients interested in the benefits of a pancreas transplant, it would be reasonable to offer SPK as the optimal treatment, even if a living kidney donor is available.

Cost-Benefit Analysis↗
PubMed1995

Diagnostic tests for alcoholism in primary health care: compared efficacy of different instruments.

BACKGROUND: Alcoholism is an uncommon diagnosis in normal medical activity despite being a prevalent health problem in Spain. One of the main obstacles that make diagnosis difficult is the lack of valid, reliable instruments of detection. The aim of the present study is to validate different tests for diagnosing alcoholism (CAGE, Alcohol Clinical Index, MCV, GGT, GOT/GPT and GGT/AP) in primary care and compare their diagnostic efficacy. METHODS: The diagnostic efficacy and discriminating power of each of the tests were calculated from the results obtained from 219 patients (out of 698 aged over 15 years) who answered the CAGE questionnaire. Patients were selected from doctors surgeries in an urban health centre. The diagnosis of alcoholism was based on the presence of DSM-III criteria and/or a daily alcohol consumption of 60 grams or more in men and 30 or more in women. RESULTS: The CAGE questionnaire showed a sensitivity of 69.86% and specificity of 80.46%, with the cut-off point at 1. The remaining tests showed a poorer diagnostic efficacy. The CAGE questionnaire scoring was the parameter that best distinguished alcoholic patients from non-alcoholic patients. CONCLUSIONS: The CAGE questionnaire demonstrates the greatest efficacy and discriminating power for diagnosing patients with alcoholism in primary care.

Adolescent↗
PubMed1995

[Alcohol consumption and the diagnosis of alcoholic patients in primary care].

OBJECTIVE: To find the frequency of investigation of alcohol-related problems and how often alcoholic patients are identified in primary care. DESIGN: A descriptive cross-sectional [correction of crossover] study. SETTING: An urban health centre. PATIENTS: 219 patients over 15 who attended an appointment occasioned by a CAGE questionnaire validation study. 108 had answered affirmatively some of the questions in the test and 111 had answered the four questions negatively. MEASUREMENTS AND MAIN RESULTS: Diagnoses of alcoholism based on the fulfillment of the DSM-III criteria and/or on the presence of alcoholic consumption of > or = 60 grammes per day for men or 30 grammes per day for women were investigated. Additionally, each patient's medical records were checked to see whether their habitual alcohol consumption or a diagnosis of alcoholism were recorded. 54 patients were diagnosed as alcoholic. Previous inquiries into consumption of alcohol were recorded in the medical records of 167 patients (76.2%). A diagnosis of alcoholism was found to be recorded in 19 of the 54 patients who fulfilled the diagnostic criteria of our study (35.2%) and in 3 patients who did not fulfil those criteria. CONCLUSIONS: Although good records of patients' habits of alcohol consumption existed, 64.8% of those diagnosed as alcoholic in our study had not been previously identified as such. This must lead us to question the efficacy of our usual diagnostic methods.

Adult↗
PubMed1994

[An evaluation of the SMAST questionnaire for the diagnosis of alcoholism in primary care. The Self-Administered Short Michigan Alcoholism Screening Test].

OBJECTIVE: To validate a self-administrable version of the SMAST questionnaire for diagnosing alcoholism at the primary care level. DESIGN: A descriptive study of a crossover type. SETTING: An urban health centre. PATIENTS AND OTHER PARTICIPANTS: 497 patients over 15, selected at random from the log-book of daily demand, answered the questionnaire. 46 patients with 2 or more positive replies concerning alcoholism (SMAST positive) were invited to a subsequent appointment, as were 40 with a lower score (SMAST negative). 30 from each group attended. MEASUREMENTS AND MAIN RESULTS: The presence of alcoholism was examined by looking at the compliance with the diagnostic criteria of the DSM-III-R and/or the existence of alcohol consumption equal to or above 30 grams a day in women and 60 in men, in those patients who attended the subsequent appointment. 20 SMAST++ positives and two negatives were diagnosed as alcoholics. There was good correlation between daily alcohol consumption in grams and SMAST scoring (r = 0.60; CI's 95%: 0.41-0.74). SMAST showed 50.48% sensitivity, 96.48% specificity and positive and negative predictive values of 66.67% and 93.33%, respectively. By means of a logistical regression analysis, it was clearly shown that the SMAST questions which best forecast the existence of alcoholism were the first two. CONCLUSIONS: The SMAST questionnaire is a very specific test for diagnosing alcoholism within primary care, although its only moderate sensitivity does not recommend it for screening purposes.

Adult↗
PubMed1994

Diminished insulin receptors on erythrocyte ghosts in nonobese patients with essential hypertension independent of hyperinsulinemia.

Hypertension is associated with insulin resistance and dyslipidemia in a syndrome named X. Epidemiologic evidence also supports a link between hyperinsulinemia and blood pressure (BP), independent of obesity and non-insulin-dependent diabetes mellitus. To assess the possible role of insulin receptors in this syndrome, we studied insulin binding by erythrocyte ghosts in patients with moderate essential hypertension with or without fasting or postglucose hyperinsulinemia. We measured plasma glucose and insulin before and at 30, 60, and 120 min after administration of 75 g glucose in 62 hypertensive patients and 20 matched normotensive controls. Both groups had comparable age (mean 45 years) and waist/hip ratios (mean 0.88). Patients undergoing antihypertensive treatment did not receive antihypertensive medication for 3 weeks. Patients with fasting or postglucose hyperglycemia were excluded from the study. Insulin binding to erythrocyte ghosts was significantly decreased (p < 0.001) to almost half the values of controls (6.5% specific binding) in both patients with hyperinsulinemic (3.2% specific binding) and those with normoinsulinemic (3.9% specific binding) hypertension. Scatchard analysis demonstrated that this was due to a lesser number of insulin receptors. These data indicate that patients with essential hypertension can show decreased erythrocyte insulin receptors without detectable hyperinsulinemia.

Adult↗
PubMed1994

A prospective evaluation of thoracoscopy for the diagnosis of penetrating thoracoabdominal trauma.

Penetrating thoracoabdominal trauma presents a difficult diagnostic dilemma. Violation of the diaphragm may be very difficult to establish. Conventional diagnostic procedures such as chest radiography, computed tomography, and diagnostic peritoneal lavage have been shown to be unreliable. Mandatory exploratory celiotomy carries a 20%-30% negative rate. Twenty-eight patients with penetrating thoracoabdominal trauma over a 6-month period were prospectively evaluated by thoracoscopy at a major urban trauma center. All patients were hemodynamically stable, had no indications for immediate celiotomy, and demonstrated thoracic injury on chest radiography or physical examination. All thoracoscopy was performed in the operating room under general anesthesia. Patients consisted of 25 males and 3 females with an age range of 15-48 years. Mechanism of injury consisted of 24 stab wounds and 4 gunshot wounds. Twelve of the procedures were for right chest wounds and 16 involved the left hemithorax. Diaphragmatic injury was identified at thoracoscopy in 9 patients (32%), with all confirmed and repaired at celiotomy. Eight of 9 patients (89%) undergoing celiotomy were found to have significant intra-abdominal injuries requiring surgical repair. Thoracoscopy was also useful for evacuation of blood from the pleural space. There were no procedure-related complications. Thoracoscopy is a safe, accurate, reliable diagnostic technique for evaluating thoracoabdominal penetrating trauma. It is less invasive than celiotomy and has the added benefit of diagnosis and therapy of the intrathoracic injuries.

Abdominal Injuries↗
PubMed1993

Problems related to alcohol consumption in primary health care: prevalence and clinical profile.

The objective of this study was to discover the medical prevalence of alcoholism in our primary care centres, the sociodemographic and clinical profile of these patients and their use of medical resources at our level of health care. The study was an observational one of a cross-sectional descriptive nature, and was set in an urban health centre. Six-hundred and ninety-eight patients aged over 15 years were selected randomly from doctors surgeries. The prevalence of alcoholism among the patients participating in our study estimated from the answers to the CAGE questionnaire, was 17.18%. Of the alcoholic patients, 90.7% were male, with a significantly lower average age than the non-alcoholics; diagnosis was more frequent in production workers than in other occupational groups. The alcoholic patients generally drank daily and consumed drinks with a high percentage of alcohol; 74.1% were smokers. The alcoholic patients were more likely to present a history of neoplasms and injuries or adverse effects than the non-alcoholics. There was a higher attendance rate among alcoholic patients who presented more severe symptoms. It was concluded that alcoholism is a highly prevalent health problem at our level of health care, and fundamentally affects young males.

Adult↗
PubMed1992

[Mental disorders and the utilization of the general medicine consultation].

OBJECTIVE: To study the quantitative relationship that exists between mental problems and use of the general medical practitioner, and the association between such problems, increased use of the medical services, and morbidity and socio-demographic variables. DESIGN: Observational cross-section study. SITE. A primary care team's general medical consultations. PATIENTS: Patients aged over 15, attending the consultations. A sample of 310 patients was selected using systematic sampling. INTERVENTIONS: The Mental Health GHQ, 28 items questionnaire was administered to the patients, to detect the existence of significant mental health disorders. MEASUREMENT AND MAIN RESULTS: Amongst older patients there is a greater incidence of mental illness, statistically significant at p less than 0.01. Also significant at p < 0.01 were the greater number of visits to the doctor amongst patients previously diagnosed as having mental disorders, amongst the elderly, those patients included in health programmes and those who showed greater take-up of supplementary explorations and interim consultations. CONCLUSIONS: The results demonstrate an association between mental illness and greater number of visits to the general practitioner, leading to the hypothesis that a considerable number of such visits could be attributed to mental illness. There is no doubt that it is important to integrate the mental health services into primary care practice.

Age Factors↗