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Biomedical subjects

J Giner

Publications and source records attributed to J Giner.

At least 19 recordsLinked to original sources

Expiratory flow limitation during exercise in competition cyclists.

In some trained athletes, maximal exercise ventilation is believed to be constrained by expiratory flow limitation (FL). Using the negative expiratory pressure method, we assessed whether FL was reached during a progressive maximal exercise test in 10 male competition cyclists. The cyclists reached an average maximal O2 consumption of 72 ml. kg-1. min-1 (range: 67-82 ml. kg-1. min-1) and ventilation of 147 l/min (range: 122-180 l/min) (88% of preexercise maximal voluntary ventilation in 15 s). In nine subjects, FL was absent at all levels of exercise (i.e., expiratory flow increased with negative expiratory pressure over the entire tidal volume range). One subject, the oldest in the group, exhibited FL during peak exercise. The group end-expiratory lung volume (EELV) decreased during light-to-moderate exercise by 13% (range: 5-33%) of forced vital capacity but increased as maximal exercise was approached. EELV at peak exercise and at rest were not significantly different. The end-inspiratory lung volume increased progressively throughout the exercise test. The conclusions reached are as follows: 1) most well-trained young cyclists do not reach FL even during maximal exercise, and, hence, mechanical ventilatory constraint does not limit their aerobic exercise capacity, and 2) in absence of FL, EELV decreases initially but increases during heavy exercise.

Adolescent

Tianeptine therapy for depression in the elderly.

1. Depression is frequent in the elderly but difficult both to diagnose and treat due to a number of distinctive features. 2. Tianeptine is a novel antidepressant with a reverse mode of action to that of the selective serotonin reuptake inhibitors yet with proven efficacy and safety. 3. 63 elderly patients (mean age:68.8 years; range:65-80 years) with depressive symptoms (major depression:55.6%; dysthymia:44.4%) were included in a 3-month open multicenter study with tianeptine (25 mg daily). 4. 43 patients (68.2%) completed the study. There were no drop-outs due to side-effects. Total Montgomery and Asberg Depression Rating Scale scores were significantly decreased (p < 0.01) on day 14, with a response rate of 76.7%. 5. Improvements were also observed in anxiety and cognitive performance. Side-effects were seen in only 11.7% of patients, with no changes in laboratory or ancillary safety parameters. Tianeptine is thus effective and well tolerated in this category of patient.

Aged

[Maximum flow meters].

The use of maximum fluid measuring instruments is a simple technique which enables one to monitor the state of air passages in patients suffering from respiratory diseases, and from asthma in particular. The use of these instruments, although simple, requires a special technique in order to evaluate changes observed over a long period of time. Graphing the numerical values obtained through observation aids in the interpretation of these values. These measurements can become a useful factor in the diagnosis, classification and treatment of asthmatic patients. Proper maintenance of these instruments is of vital importance so that they function correctly. All of these factors come into play to contribute to making maximum fluid measuring instruments become "respiratory thermometers".

Asthma

[Evaluation of 6 portable meters for measuring peak expiratory flow].

The aim of this study was to evaluate six peak flow meters, comparing them to a flow signal recorded under laboratory and clinical conditions (LC and CC, respectively). The six peak flow meters studied were the PF-Control (A), the Personal Best (Healthscan) (B), the logarithmic scale and linear Vitalographs (Vitalograph) (C and D), the Miniwright (Airmed) (E), and the Assess (Healthscan) (F), LC: Readings were compared to those obtained with a computer-controlled syringe attached to a servomechanism (Pulmonary Waveform Generator System) at flow levels of 185, 302 and 595 L/m before and after clinical measurements. CC: Readings from each model, taken randomly and consecutively, were compared with those obtained by pneumotachometer in 50 individuals with different air flow levels (range 86 to 888 L/min), ending by repeating the measurement procedure with the first device used. The LC results were as follows: precision varied among the six models from 0.9% (F) to 9.4% (E), and in no case was there a statistically significant difference from the servosyringe reading; reproducibility (coefficient of variation) ranged from 0.7% (F) to 3.3% (B); stability after clinical testing showed results that differed from those of the servosyringe in a range of -18.3 L/min (A) to +16.7 L/min (B) and the difference was significant only for device B. The CC results were as follows: in comparison with the pneumotachometer readings, percent error was within NHLBI limits for devices A and B in excess of the limits for the other peak flow meters. Analysis of concordance showed that differences were related to level of flow for all devices except F and that measurement errors conformed to an equation of linear regression. We conclude that all the studied models give readings that are biased in direct proportion yo the flow measured. Precision was good and the devices remained stable over more than 200 readings, such that peak flow meters are appropriate for repeated measurements in a single patient.

Evaluation Studies as Topic

[Health workers' knowledge and skills regarding the use of the Turbuhaler inhaler].

The aim of this study was to evaluate health care workers' theoretical knowledge and skill in managing the dry powder Turbuhaler. We studied 118 individuals in three groups: 50 nurses, 34 medical residents and 34 staff physicians. Theoretical knowledge was evaluated by a questionnaire specifically designed for the purpose. Skill in managing the device was analyzed by evaluating a practical demonstration of the inhaling technique generally recommended, using a placebo inhaler. Six percent of staff physicians, 3% of the residents and 2% of the nurses answered the theoretical questionnaire correctly. Twenty-one percent of the staff physicians, 15% of the residents and 6% of the nurses inhaled correctly. However, when skill in managing the inhaler was evaluated against the maneuvers recommended by the manufacturer (which do not oblige exhaling before inhaling through the device and then holding the breath), there was significant improvement: 41% of the staff physicians, 23% of the residents, and 20% of the nurses inhaled correctly. We can conclude by saying that: a) our health care workers' general knowledge about how to handle the Turbuhaler device is deficient; b) the proportion of correct inhalation maneuvers observed doubles when these are assessed according to the manufacturer's recommendations, and c) health care workers should receive specific training in the inhalation techniques required for using the various devices usually prescribed.

Clinical Competence

[Compliance with the "recommendations SEPAR" on spirometry].

The objective of this study was to assess Spanish performance of spirometry and to determine the extent to which practice is in accordance with the 1985 SEPAR recommendations. To that end we formulated a questionnaire with 31 items in two sections, 10 covering basic aspects of compliance with necessary techniques and 21 general questions. The questionnaire was sent to all SEPAR members. One hundred eight responses were received. The results show that the typical spirometric measurement was forced expiration without a bronchodilator test by way of a pneumotacograph, with simultaneous representation of the flow/volume curve. Calibration, when performed, is done daily with a 3 1 syringe and atmospheric data are checked. Spirometric measurements are usually obtained by a registered nurse, who also collects anthropometric data directly from the patient. The patient is usually seated with the nose occluded. At least three and at most eight satisfactory readings are obtained. The criteria for starting and ending the maneuver and the reference values used are those recommended by SEPAR. The equipment is washed weekly with soap and water; calibrations and equipment incidences are not recorded. The level of compliance with 1985 SEPAR norms for forced spirometry is adequate with respect to some technical equipment questions but deficient on basic procedure and quality control.

Data Collection

[A new device for measuring occlusion pressure].

Mouth pressure in the first 100 ms of inspiration with the airway occluded (P0.1) is an indirect measure of central airways activity. Few adequately validated devices are available on the market for measuring this variable automatically, impeding wider use of this measurement. Our aim was to determine the validity and precision of a new automatized manometer for measuring P0.1 and compare the device to the apparatus normally used in our laboratory. The newly manufactured device consisted of a semiconductor type pressure transduce connected to an analog-to-digital converter. The usual apparatus used was constructed in our laboratory from a Honewell transducer, an analog-to-digital card (Data Translation DT2801) for an IBM-compatible PC and a standard spread sheet program. Both devices recorded a continuous signal at a sample frequency of 100 Hz. To determine linearity, accuracy, sensitivity and precision, two columns of 5 and 25 cmH2O were used. For clinical assessment, 33 patients scheduled for lung function analysis were tested. Five measurements of P0.1 were performed on each. The sensitivity of the new device was 0.1 cmH2O; precision expressed as a variation coefficient was 0%, and linearity expressed as a correlation coefficient was r = 0.999 between the two columns. The mean difference between the two devices was 0.11 (0.46) cmH2O (p < 0.0001). Analysis of concordance confirmed a reading bias for the new device in comparison with the usual one, although the difference was not clinically significant (0.08 to 0.14 cmH2O). We conclude that the new device gives good results and its availability on the market may allow more frequent clinical application of occlusion pressure measurement.

Bite Force

Pain during arterial puncture.

STUDY OBJECTIVE: To quantify the level of pain reported by patients during arterial puncture with or without local anesthesia, and to compare the results with levels reported for venous puncture. DESIGN: Double-blind study of puncture with and without local anesthesia. SETTING: Pulmonary function laboratory, department of pneumology. PATIENTS: We studied 270 consecutive patients undergoing arterial puncture divided into two groups. In group A (n = 210), we assessed level of pain with and without local anesthesia and with placebo. In group B (n = 60), we compared pain of arterial and venous puncture. INTERVENTIONS: The arterial puncture was performed in the radial artery; venous puncture was in the median basilic vein. MEASUREMENTS AND RESULTS: The pain was quantified on a visual analog scale (10 cm). Mean level of pain for all arterial punctures without anesthesia or placebo was slight to moderate (3.01 +/- 1.94 cm). Subcutaneous anesthetic infiltration before arterial puncture significantly reduced pain by more than 50%, to 1.50 +/- 1.54 cm, a level that was significantly lower than the pain level reported after conventional venous puncture (1.80 +/- 1.10 cm). The pain reported by patients who received no anesthesia was not significantly different (p = 0.45) from that perceived by those who received subcutaneous infiltration of saline solution (placebo). CONCLUSIONS: Arterial puncture with prior infiltration of local anesthetic is the least painful procedure among those studied. Use of local anesthesia is indicated whenever conventional arterial puncture is required.

Anesthesia, Local

[Arterial puncture in Spain. A follow-up of the SEPAR 1987 guideline. Sociedad Española de Neumología y Cirugía Torácica].

This study sought to evaluate the procedures used for measuring arterial gases in our hospitals and determine the level of compliance with the 1987 SEPAR guidelines. Questionnaires covering the obtention, transport, storage and analysis of samples, as well as familiarity with the guidelines were distributed to 150 pneumology, internal medicine, intensive care and emergency services; 78 centers responded (71% from pneumology departments). General information obtained was as follows: arterial puncture is carried out by nurses without anesthesia and using syringes for gases; the radial artery is used; with post-puncture pressure provided by the patient; the sample is analyzed within 15 minutes and cold storage is used. The department's own automatic analyzer is used. Buffered gases and solutions are used for calibration and quality control measures are rare. Some aspects of the guidelines are unfamiliar. We believe that an effort should be made to extend application of the guidelines in order to improve arterial blood gas analysis.

Arteries

Measurement of maximal static respiratory pressures at the mouth with different air leaks.

The effect of two different circuit leaks on the measurement of maximal static inspiratory and expiratory pressures at the mouth (Pimax, Pemax) was assessed in 70 patients with respiratory disease. Patients were divided into three groups with similar anthropometric and spirometric characteristics. The first group (30 patients) had their Pmax measured with a leak of 2.0 mm internal diameter (ID) and 37 mm length (as proposed by T. Ringqvist) and repeated with a second leak of 1.0 mm ID and 15 mm length (as recommended by J. L. Clausen). The two measurements were done in random order. Measurements for the other two groups (20 patients each) were taken with one or another, the two leaks randomly alternated with no leak. Pimax measurements obtained with Ringqvist's leak were 17 percent (p less than 0.005) lower than those with Clausen's leak and 22 percent (p less than 0.005) lower than those with no leak. Pemax measurements performed with Ringqvist's leak in place were 11 percent (p less than 0.005) lower than those with Clausen's leak and 11 percent (p less than 0.005) lower than those obtained with no leak. The comparison between Clausen's leak and no leak showed no statistically significant difference. We conclude that whenever the effect of pressure generated in the mouth is to be avoided in the measurement of respiratory Pmax, a leak of the size proposed by Ringqvist is to be preferred.

Asthma

Moclobemide versus clomipramine in the treatment of depression: a multicentre trial in Spain.

The efficacy, tolerability and safety of moclobemide were compared with those of clomipramine in a double-blind, randomized parallel group study over 4 weeks. Patients were suffering from various forms of depression: 33 received moclobemide and 31 clomipramine. The mean score on the Hamilton Rating Scale for Depression decreased gradually in both groups, with no significant differences between them; the final scores showed an improvement of 57% in the moclobemide group and 60% in the clomipramine group, compared with baseline. The investigators' assessment of efficacy at the end of treatment was good or very good for 60% of moclobemide patients and 50% of clomipramine patients, and tolerance was good or very good for 31 patients on moclobemide and 26 on clomipramine. The drugs thus showed comparable antidepressant efficacy, and both were mostly well tolerated, although adverse events were more prevalent in patients treated with clomipramine.

Adult

Patterns of consumption of alcohol in Seville, Spain. Results of a general population survey.

The results of a general population survey of the patterns of consumption of alcohol in a representative sample of the province of Seville, Spain, are analysed in this article. The proportions of drinkers and abstainers and distribution by age, by sex and by urban-rural residency are discussed. Frequency of consumption declines as age increases in both sexes but the negative slope is more marked in females. Analysis of the results on quantity of alcohol consumed during the week prior to the interview shows that men drink more heavily than women in all age-groups and young people drink more heavily than other age-groups. The combination of data on frequency of consumption and maximum quantity of alcohol reportedly consumed on the highest drinking occasion shows that the majority of men belong to the High Frequency-Low Quantity typology, followed by High Frequency-Medium Quantity, but in women nearly 60% belong to the Low Frequency-Low Quantity typology, followed by High Frequency-Low Quantity. The highest proportions of both abstainers and heavy drinkers are found in the group of people with the lowest income.

Adolescent

Electrocatalytic glucose sensor.

High surface area platinum subjected to the appropriate electrical potential cycling regimes exhibits considerable electrocatalytic activity towards glucose oxidation. We have developed a special data processing method, the compensated net charge (CNC) method, to take advantage of the electrocatalytic activity of platinum. This method involves the determination of the net oxidation charge during one complete cycle of a cyclic voltammogram applied to the platinum electrode in a potentiodynamic mode. Under these conditions, the electrode response is very sensitive to glucose, completely insensitive to urea, and only moderately sensitive to amino acid concentration changes. Earlier work with other endogenous and exogenous potential co-reactants shows little interference. Data obtained in vitro and in vivo will be presented and discussed.

Animals

Serum lipid levels before and after vasectomy in men.

The blood lipid profile was determined in sixty-two men, 24 to 62 years old, before and two, six and twelve months after surgical occlusion of the vas deferens. No statistically significant differences were found in mean body weight, blood pressure, serum levels of non-esterified fatty acids, total lipids, triglycerides, total cholesterol and alpha, beta and prebeta fractions of the lipoproteins, which were measured before and after surgery. When the serum levels of the alpha and beta fractions were considered in the same subject, it was observed that 12 months after vasectomy a similar percentage of cases showed a predominance of either one of them. Hence, no modifications on the lipid profile of these subjects were found that could indicate an increased risk of arteriosclerotic disease.

Adult