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Biomedical subjects

G Gutierrez

Publications and source records attributed to G Gutierrez.

At least 37 records · Page 2Linked to original sources
PubMed1998

An intercultural comparison of home case management of acute diarrhea in Mexico: implications for program planners.

BACKGROUND: The objective was to assess the extent to which similarities in cultural beliefs and practices related to home management of diarrhea would permit general recommendations to improve the content of health care messages. METHODS: We studied six communities in Mexico, covering rural and urban conditions, different ethnic groups, and different socioeconomic levels. Systematic data collection relied on open-ended, face-to-face interviews with mothers of children under 5 years of age who had had an episode of diarrhea. Similarities among communities were assessed by means of a quadratic assignment procedure applied to signs, symptoms, and treatment matrices. Significant similarity among most of the communities sustained use of a global composite matrix to represent all communities. RESULTS: We suggest specific recommendations to promote sound home management of diarrhea based on significant correlations among signs and symptoms with treatments. Signs and symptoms include those promoted by the National Program for the Control of Diarrheal Diseases (diarrhea, fever, vomiting) and others commonly mentioned by mothers (stomach ache, sadness, restlessness, refusal to eat). Similarly, recommendations to use home-based treatments based on beliefs related to their use may include the feeding of rice water, soups, and broth to a child who is sad, or rice-gruel and teas for a child with a fever. CONCLUSIONS: Our study supports that there are enough similarities among mothers' beliefs and practices for the care of acute diarrhea in childhood to support general recommendations at the program level.

Acute Disease↗
PubMed1997

Management of radial head fracture.

A fracture involves not only bone, but also surrounding soft tissues. Attention to soft tissue injury may help prevent long-term complications such as contractures, weakness, instability and loss of proprioception. Appropriate treatment is directed at three phases of healing: inflammation, repair and remodeling. The two- to seven-day inflammatory phase is controlled with rest, ice, elevation, immobilization and medications to reduce the pain and swelling. Immobilization during the two- to eight-week repair phase promotes bone healing but may lead to contractures and loss of strength if continued for too long. Physical therapy during the several-month remodeling phase helps restore strength, range of motion and proprioception. Although six to eight weeks is a usual estimate for fracture healing, the actual time can be affected by the type of fracture and the person's age, nutritional and health status, and medication use. This review of the diagnosis and treatment of radial head fractures illustrates the importance of directing the treatment toward the three phases of healing.

Humans↗
PubMed1997

Measurement of gastric mucosal carbon dioxide tension by saline and air tonometry.

PURPOSE: This study compares the balloon air tonometry method of measuring gastric mucosal CO2 to standard saline tonometry. Also, this study investigates the effect of histamine-2 receptor blockade on the precision of tonometric measures of gastric mucosal PCO2 (PtCO2). MATERIALS AND METHODS: We obtained hourly measurements of PtCO2 from two gastric tonometers inserted orally in 19 healthy volunteers. One tonometer measured PtCO2 by the intermittent saline method, whereas the other measured PtCO2 using a newer continuous air method. Subjects received intravenous 5% dextrose during the first 6 hours of the experiment followed by a continuous infusion of a solution of ranitidine in 5% dextrose for another 6 hours. The ranitidine infusion was titrated to maintain gastric fluid pH > or = 4. RESULTS: Comparison of air to saline tonometry yielded a bias of -1.3 mm Hg with a limit of agreement of 6.6 mm Hg under optimal conditions of optimal gastric fluid pH (gastric fluid pH > or = 5.0). Measures of PtCO2 were lower with ranitidine for either group, 45.3 +/- 1.3 mm Hg versus 39.7 +/- 0.5 mm Hg for saline (P < .01) and 45.9 +/- 1.0 versus 41.3 +/- 0.5 for air (P < .01). The mean PCO2 gap (PtCO2-P(arterial)CO2) at gastric fluid pH > or = 5.0 was 1.4 mm Hg, with a standard deviation of 2.7 mm Hg. A span of three standard deviations yields a normal limit for PCO2 gap of 9.5 mm Hg. CONCLUSION: Measures of PtCO2 with the air tonometer method are similar to those obtained with saline tonometry. The reliability of PtCO2 measurements with either method improved with the use of ranitidine to maintain gastric fluid pH > or = 5.

Adult↗
PubMed1997

Infant mortality due to acute respiratory infections: the influence of primary care processes.

A population-based case control study was conducted to ascertain whether the process of primary care can be a determinant of infant mortality due to Acute Respiratory Infection (ARI). Cases were 118 infants who died from ARI, individually matched with 118 infants who suffered an ARI episode and recovered. Information was gathered through interviewing mothers. Study variables were assembled into five subsets: children's characteristics; mothers' characteristics; access to medical services; process of primary care, and; sociodemographic variables. An index per subset was built to analyze the independent influence of each on ARI death risk. The index was constructed upon the weighted sum of the adjusted odds ratios (OR) within each subset. Then, the values of each index were collapsed into high/low values with the 50 percentile as a cut-off value. Next, by means of a conditional logistic regression procedure, an explanatory model of ARI mortality was obtained. The final multivariate model included the indexes that showed an independent effect: I) Process of care (OR 9.68, CI 95% 3.59-26.1): inadequate referral, attention provided by more than one physician and being attended by a private physician; II) children's characteristics (OR 7.22, CI 95% 2.35-22.2): perinatal history, lack of breast-feeding and incomplete immunization scheme; III) access to medical services (OR 5.27, CI 95% 2.02-13.7): geographic and economic barriers, lack of confidence in public health services, and; IV) mothers' characteristics (OR 4.03, CI 95% 1.18-13.8), mainly represented by untimely care seeking. We conclude that the management of the disease is a key determinant in which factors relating to the mother and the health services are strongly related. Our study reveals untimely care seeking, difficult access and inadequate disease treatment as important factors which deserve careful attention in the future. We also confirm the importance of biological determinants previously described. A main strategy to reduce infant mortality due to ARI should be to encourage training of primary care physicians, including private practitioners, focused on providing effective case management and emphasizing the education to mothers.

Acute Disease↗
PubMed1996

Human skeletal muscle nebulin sequence encodes a blueprint for thin filament architecture. Sequence motifs and affinity profiles of tandem repeats and terminal SH3.

Analysis of deduced protein sequence and structural motifs of approximately 5500 residues of human fetal skeletal muscle nebulin reveals the design principles of this giant multifunctional protein in the sarcomere. The bulk of the sequence is constructed of approximately 150 tandem copies of approximately 35-residue modules that can be classified into seven types. The majority of these modules form 20 super-repeats, with each super-repeat containing a 7-module set (one of each type in the same order). These super-repeats are further divided into eight segments: with six segments containing adjacent, highly homologous super-repeats, one single repeat segment consisting of 8 nebulin modules of the same type, and a non-repeat segment terminating with a SH3 domain at the C terminus. The interactions of actin, tropomyosin, troponin, and calmodulin with nebulin fragments consisting of either repeating modules or the SH3 domain support its role as a giant actin-binding cofilament of the composite thin filament. Such affinity profiles also suggest that nebulin may bind to tropomyosin and troponin to form a composite calcium-linked regulatory complex on the thin filament. The modular construction, super-repeat structure, and segmental organization of nebulin sequence appear to encode thin filament length, periodicity, insertion, and sarcomere proportion in the resting muscle.

Actin Cytoskeleton↗
PubMed1996

Does gastric tonometry work? Yes.

Gastric tonometry is gaining acceptance rapidly as a noninvasive method of monitoring tissue dysoxia in a key organ system that previously could not be assessed easily. In addition to being noninvasive, gastric tonometry also identifies dysoxia in shock sooner than currently available monitors. This allows for more timely intervention with a subsequent improvement in prognosis in defined groups of patients. Tonometry data that suggest continued dysoxia despite intervention should signal clinicians to seek alternative diagnoses or to question the efficacy of current therapies, including antibiotics.

Blood Gas Monitoring, Transcutaneous↗
PubMed1996

Tonometry. A review of clinical studies.

In the quest for a better monitor of end-organ injury in the critically ill patient, gastrointestinal tonometry to measure intramucosal pH (pHi) and PCO2 has been advocated by several investigators. The authors discuss the principles and practice of gastric tonometry. In addition, the clinical applications of the technique are discussed with close attention to the use of pHi as an indicator of mucosal ischemia, ICU morbidity rates, and ICU mortality rates in surgical and medical patient populations. Although prognostic capability is an important role for tonometry, the principal benefit of the technology is its efficacy as an index of tissue resuscitation and as a guide to medical intervention. Given recent technical advances, gastrointestinal tonometry may gain increasing use in the assessment of tissue perfusion and oxygen metabolism.

Carbon Dioxide↗
PubMed1996

Pulmonary lactate release in patients with sepsis and the adult respiratory distress syndrome.

PURPOSE: Elevated arterial lactate concentrations in patients with sepsis have been interpreted as evidence of peripheral, nonpulmonary tissue hypoxia. These patients often develop pulmonary failure manifested by the acute respiratory distress syndrome (ARDS). As the result of tissue hypoxia or inflammation, the lungs of patients with sepsis and ARDS may become a source of lactate release into the circulation. MATERIALS AND METHODS: Pulmonary lactate release was measured in 19 patients with sepsis, arterial lactate > or = 2.2 mm, and gastric mucosal pH > 7.30. A normal gastric mucosal pH served as a marker of adequate splanchnic oxygenation. Pulmonary lactate release was computed as the product of the cardiac index and the difference in plasma L-lactate concentration in simultaneously obtained arterial and mixed venous blood samples. Lung injury was graded with the Lung Injury Score using radiographic and physiologic data. RESULTS: The lungs of patients with minimal or no lung injury (lung injury score <1) produced significantly less lactate than those with moderate or severe lung injury (lung injury score > or = 1) (P < .005). The Lung Injury Score correlated with pulmonary lactate release (r2 = .73; P < .0001). This relationship resulted primarily from increases in mixed venous-arterial lactate differences (r2 = .59). The Lung Injury Score correlated weakly with the cardiac index (r2 = .32). Arterial lactate concentration did not correlate with pulmonary lactate release, systemic oxygen transport, or systemic oxygen consumption. CONCLUSIONS: The lungs of patients with sepsis and ARDS may produce lactate. Pulmonary lactate release correlates with the severity of lung injury. The contribution of pulmonary lactate release should be considered when interpreting arterial lactate concentration as an index of systemic hypoxia.

Acidosis, Lactic↗
PubMed1996

Reversal of muscle fatigue in intact rabbits by intravenous potassium chloride.

PURPOSE: Skeletal muscle fatigue has been associated with potassium efflux from the myocytes, resulting in endogenous increases in blood potassium concentration ([K+]). Conversely, exogenous increases in extracellular [K+] potentiates contraction in isolated muscle preparations. The mechanisms responsible for these contradictory effects of [K+] on skeletal muscle function are unknown. Moreover, little is known about the effect of exogenous increases in [K+] on force generation by intact animals, given potassium's deleterious effect on cardiac function. METHODS: We compared the response to exogenous increases in blood [K+] in rabbits given an infusion of potassium chloride (KCl) intravenously (IV) (0.2 mol/L; KCl group; n = 7) to a group given 0.9% sodium chloride (NaCl) (control; n = 7). The rabbits underwent low-frequency, isometric twitch stimulation of the left hindlimb (square wave pulses 100 microseconds, 40V, 0.25 Hz) throughout the experiment. Both groups received 0.9% NaCl (25 mL/h) during the first hour of twitch stimulation and experienced similar decreases in hindlimb forces to 70% of initial force. A continuous infusion of KCl or of saline (60 mL/h) was started, and hindlimb stimulation continued for 2 hours. RESULTS: There were no changes in [K+] in the control group, and twitch forces progressively declined during the next 2 hours (369 +/- 47 g to 279 +/- 34 g, P < .01). Arterial [K+] increased in the KCl group from 2.6 +/- 0.1 to 10.1 +/- 0.5 mmol/L (P < .01), and hindlimb twitch forces almost doubled (418 +/- 49 g to 756 +/- 55 g, P < .01). Force frequency curves showed improved contractility in the KCl group at stimulation frequencies below 30 Hz. CONCLUSIONS: Exogenous increases in blood [K+] potentiate skeletal muscle contraction in intact animals and reverse low-frequency twitch fatigue. A possible mechanism may be the maintenance of intracellular [K+] by hindering K+ efflux from skeletal muscle cells.

Animals↗
PubMed1996

Evaluation of the Abbott Cell-DYN 3500 hematology analyzer in university hospital.

The Abbott (R) Cell-Dyn 3500 (Abbott CD 3500, Abbott Diagnostics Division, Mountain View, CA) is a fully automated hematology analyzer capable of providing a complete blood count (CBC) profile, including a five-part differential leukocyte count (DLC) and flagging system in this study. The CBC profile and DLC flagging system of the Abbott CD 3500 were evaluated according to the HA-20 protocol of the National Committee for Clinical and Laboratory Standards (NCCLS) and compared to the Technicon H*2 blood analyzer currently used in the authors' laboratory. Linearity, carryover, precision, and stability were all within the limits established by the manufacturer. No significant break-downs were found during the evaluation period. Evaluation of DLC indicated an excellent correlation with the manual reference method for neutrophils, lymphocytes, and eosinophils (r = 0.916, 0.936, 0.967, respectively), a good correlation for monocytes (r = 0.811) and a poor correlation for basophils (r = 0.224). Overall flagging for morphologic abnormalities displayed higher sensitivity (85%) than specificity (67%), with a false-positive ratio of 33%. In general, these results are in accordance with those obtained by other authors in the same period of time.

Academic Medical Centers↗
PubMed1996

Gastrointestinal tonometry: a monitor of regional dysoxia.

There is sufficient information in the clinical literature to support the prognostic utility of gastric tonometry. Gastric tonometry measures increases in mucosal PCO2, a very useful physiologic signal. This information helps clinicians judge the state of energy balance in a tissue that is exquisitely sensitive to alterations in perfusion and oxygenation. Furthermore, the information obtained with gastric tonometry comes at relatively low cost and with minimal risk to the patient. At present, gastric tonometry has the drawback of being a relatively cumbersome technique that is labor intensive and prone to errors. New technological advances should improve both the ease of use and the timeliness of the information, and minimize measurement errors.

Carbon Monoxide↗