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J Llorca

Publications and source records attributed to J Llorca.

At least 19 recordsLinked to original sources
PubMed2001

Case-control study and meta-analysis of low density lipoprotein receptor-related protein gene exon 3 polymorphism in Alzheimer's disease.

The low density lipoprotein receptor-related protein (LRP) may influence both the clearance and the production of beta-amyloid peptide and thus plays a role in Alzheimer's disease (AD) pathogenesis. Previous studies, although inconsistent, have suggested that the LRP exon 3 CC genotype contributes to the risk of AD. A case-control study utilizing a clinically well-defined group of 305 sporadic AD patients and 304 control subjects was performed to test this association in an ethnically homogeneous population from Spain. In the current study, the LRP CC genotype was not over-represented in AD patients compared to non-demented controls. A meta-analysis of previous studies revealed a weak correlation of LRP CC genotype with AD (odds ratio of 1.35, P=0.01).

Aged↗
PubMed2001

Dichloro(d-methionine-n,s)platinum(ii) at 130 k.

The asymmetric unit of the title compound, [PtCl2(C5H11NO2S)], a D-methionine derivative, contains two molecules with opposite chirality at the S atoms. The amino acid acts as a bidentate ligand and coordinates simultaneously through the N (amino) and S (thioether) atoms. The molecules are packed in pairs which are connected through two hydrogen bonds between the protonated carboxyl groups, with O.O distances of 2.633 (10) and 2.663 (12) A.

Crystallography, X-Ray↗
PubMed2001

[Risk factors for nosocomial sepsis: a case-control study].

BACKGROUND: The objective of this study was to identify the risk factors associated with the nosocomial sepsis syndrome according to the criteria of the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference. PATIENTS AND METHOD: A 1-year prospective case-control study matched for sex, age (+/- 5 years), and pre-infection hospital stay (+/- 1 day) was performed in a 1,200-bed university hospital. Cases were selected according to the above criteria. Controls were randomly selected from the daily list of hospitalized patients. Crude and adjusted odds ratios (OR) were determined. RESULTS: 346 cases and 346 controls were included. Multivariate analysis identified the following intrinsic risk factors: coma in the 48 hours before sepsis (OR: 15.1; CI 95%, 5.6-41.2), renal failure (OR: 3.4; CI 95%; 1.5-10.8), neoplasm (OR: 2.4; CI 95%, 1.1-5.1), prosthesis material (OR: 2.7; CI 95%, 1.0-7.8), and serum albumin concentration at admission lower than 3.1 g/dl (OR: 5.3; CI 95%, 2.3-12.4). Main extrinsic risk factors were: previous nosocomial infection (OR: 12.5; CI 95%, 1.61-96.3), intensive care unit (ICU) stay (OR: 10.6; CI 95%, 3.1-36.2), naso-gastric tube (OR: 8.4; CI 95%, 2.3-31.3), indwelling urinary catheter (OR: 5.0; CI 95%, 1.4-18.9), H2 blockers treatment (OR: 5.0; CI 95%, 1.6-15.2), and IV central line (OR: 4.1; CI 95%, 1.2-14.0). CONCLUSION: In our study, main risk factors for development of nosocomial sepsis were presence of coma in the 48 hours before sepsis, ICU stay, and prior cross infection during hospitalization.

Adolescent↗
PubMed2001

The --491 TT apolipoprotein E promoter polymorphism is associated with reduced risk for sporadic Alzheimer's disease.

Homozygosity for the A allele of the -491 A/T apolipoprotein E (APOE) promoter polymorphism has recently been reported to be associated with sporadic Alzheimer's disease (AD). Two hundred and fifty one patients with AD and an equal number of controls derived from the same region in a Spanish population, were genotyped for -491 A/T and epsilon2/epsilon3/epsilon4 APOE polymorphisms. We did not detect an elevated -491 AA genotype frequency when comparing AD cases to controls. In contrast, persons homozygous for the T allele were at a significantly reduced risk of AD (odds ratio of 0.10, P=0.006). Multiple logistic regression analysis indicated that the -491 TT polymorphism added information on the risk of AD which was independent of that of the APOE epsilon4 allele.

Adult↗
PubMed2001

Biopsy-negative giant cell arteritis: clinical spectrum and predictive factors for positive temporal artery biopsy.

OBJECTIVES: To examine the frequency and features of patients with biopsy-negative giant cell arteritis (GCA), establish differences with biopsy-proven GCA, and identify the optimal set of predictors for a positive temporal artery biopsy (TAB) in patients with GCA. METHODS: Retrospective study of an unselected population of patients with GCA diagnosed at the reference hospital for a defined population between 1981 and 1998. Patients were classified into biopsy-proven GCA if a TAB was positive for GCA, or biopsy-negative GCA if they fulfilled the American College of Rheumatology 1990 criteria for the classification of GCA (Hunder GG, et al Arthritis Rheum 1990; 33:1122-8) despite having a negative TAB. RESULTS: One hundred ninety Caucasian patients were diagnosed with GCA. Twenty-nine of them (15.3%) had a negative TAB. In these biopsy-negative patients, headache and polymyalgia rheumatica were frequent presenting symptoms. In contrast, jaw claudication, abnormal temporal artery on physical examination, and constitutional syndrome (asthenia, anorexia, and weight loss of 4 kg or more) were less common. They also had lower biologic markers of inflammation. The best predictive model of biopsy-proven GCA included a history of constitutional syndrome (OR = 6.1), an abnormal temporal artery on physical examination (OR = 3.2), and the presence of visual complications (OR = 4.9). CONCLUSIONS: In GCA, a subset of patients have a high likelihood of having a negative TAB. This subset seems to have less severe ischemic complications than that of biopsy-proven GCA. In patients without visual manifestations, abnormal temporal artery on examination or constitutional syndrome the risk of having an abnormal TAB is low.

Aged↗
PubMed2001

Efficacy of surveillance in nosocomial infection control in a surgical service.

OBJECTIVE: The purpose of this study was to assess the efficacy of surveillance of nosocomial infection in infection control at a service of general surgery. DESIGN: A surveillance study that included 1483 patients with a prospective identification of nosocomial infection was carried out. Its results were discussed with the staff, and a program on nosocomial infection control was implemented. One year after the pre-intervention study, a similar study that included 1506 patients was done. The main outcome measure was nosocomial infection. Incidence rates, incidence rate ratios, crude and multiple-risk factor adjusted for by Poisson regression analysis, and their 95% confidence interval rates were estimated. RESULTS: The characteristics of the patients enrolled in both studies were compared. After the intervention, the trend was to attend patients with more severe conditions: higher frequency of liver failure, chronic obstructive lung disease, higher proportion of dirty surgical wounds, and higher scores of both Study on the Efficacy of Nosocomial Infection Control (SENIC) and National Nosocomial Infections Surveillance indices. There were no significant differences in emergency surgery, duration of surgery, age, and sex. After the intervention, unnecessary chemoprophylaxis was drastically reduced, and a significant reduction in preoperative stay was observed. The nosocomial incidence rate fell from 18.4 to 14 per 1000 patient-days. This reduction yielded an incidence rate ratio of 0.56 (95% confidence interval, 0.43%-0.74%) adjusted for several variables (SENIC index, serum creatinine level, serum albumin level, antihistamine H2 level, surgical wound, body mass index, chemoprophylaxis, and community-acquired infection). Significant reductions in surgical site infection and urinary tract infection were observed, but the rate of respiratory tract infection remained unchanged. CONCLUSIONS: Surveillance was effective in reducing nosocomial infection.

Cross Infection↗
PubMed2001

Epidemiology of surgical-site infections diagnosed after hospital discharge: a prospective cohort study.

OBJECTIVE: To study postoperative infections in hospital and after discharge, and to identify the risk factors for such infections. DESIGN: Prospective cohort study, with telephone follow-up for 1 month after hospital discharge. SETTING: The general surgery service of a tertiary hospital in Spain. MAIN OUTCOME MEASURE: In-hospital and postdischarge surgical-site infection (SSI), always confirmed by a physician. RESULTS: Of the 1,506 patients initially enrolled, 29 died during hospital stay, and 33 were lost to postdischarge follow-up. An SSI was identified prior to discharge in 123 patients and after discharge in 103. For several variables (age, serum albumin, glycemia, lengths of preoperative and postoperative hospital stay, etc), there were no differences between patients with postdischarge SSI and noninfected patients; however, there were differences detected between patients with postdischarge SSI and in-hospital SSI, as well as between patients with in-hospital SSI and noninfected patients. The analysis of risk factors showed that most predictors for in-hospital SSI did not behave in the same manner for postdischarge SSI. Stepwise logistic regression only identified chemoprophylaxis, age (advanced age was a preventive factor), and body mass index as independent risk factors for postdischarge SSI. Differences in risk factors between in-hospital and post-discharge SSIs remained even after controlling for time from operation to diagnosis. CONCLUSIONS: Most predictors of in-hospital SSI were not predictors of postdischarge SSI.

Age Factors↗
PubMed2001

Competing risks analysis using Markov chains: impact of cerebrovascular and ischaemic heart disease in cancer mortality.

BACKGROUND: A decrease in cerebrovascular disease (CVD) and ischaemic heart disease (IHD) mortality can produce an increase in mortality from other causes, even cancer. This problem is called the competing risks problem. METHODS: A Markov chain is used to analyse the interrelation between CVD, IHD and cancer mortalities in Spanish women in 1981 and 1994. We compare the results using two models: discarding CVD and IHD mortality (the elimination model) and substituting CVD and IHD 1981 mortality rates in 1994 figures (the constant model). RESULTS: Removing mortality from CVD and IHD increases cancer mortality rates in women aged > or = 70, and the probability of death from cancer rises from 10.7% to 13.3%. In the second model, the use of CVD and IHD 1981 mortality rates in 1994 data yields slightly lower mortality rates and so the impact of CVD and IHD mortality changes in the period 1981 to 1994 is negligible except in elderly women. CONCLUSIONS: Although IHD and CVD mortality have decreased in all age groups of Spanish women from 1981 to 1994, this has not had a great impact on cancer mortality.

Adult↗
PubMed2001

Rheumatic manifestations of infective endocarditis in non-addicts. A 12-year study.

Infective endocarditis (IE) is due to a microbial infection of the heart valves or of the endocardium in close proximity to either congenital or acquired cardiac defects. This infection is associated with a high risk of complications. Rheumatic manifestations are known to be frequent complications of IE. Controversy, however, frequently exists about the actual incidence of these complications. This may be due to the small number of series describing the frequency and type of rheumatic manifestations, the absence of uniform criteria used for the diagnosis of IE, and the fact that some studies on rheumatic manifestations in IE have been described from tertiary referral centers, which implicates associated problems of referral bias and uncertainty of denominator population. To investigate further the incidence, clinical spectrum, and outcome of patients with IE and rheumatic manifestations, we examined the features of patients diagnosed with clinically definite IE according to the Duke classification criteria at the single reference hospital for a defined population in northwestern Spain during a 12-year period. Between 1987 and 1998, 100 consecutive patients had 110 episodes of clinically definite IE. Rheumatic manifestations were observed in 46 of the 110 episodes (41.8%). As in other western countries, they occurred more commonly in men aged in their 50s. The most frequent valve involved was the aortic (43.5%) followed by the mitral valve (30.4%). Myalgia was a frequent symptom. Peripheral arthritis, generally as monoarthritis, was clinically evident in 15 cases (13.6%), and sacroiliitis in 1 patient. Low back pain was described in 14 cases (12.7%). Septic discitis was observed in 2 cases, and biopsy-proved cutaneous leukocytoclastic vasculitis was found in 4 cases. Other conditions such as trochanteric bursitis and polymyalgia were observed in 2 and 1 case, respectively. Apart from a significantly higher frequency of hematuria and a trend to lower serum complement levels in patients with rheumatic complications, no differences in clinical features, laboratory tests, or microbiologic blood culture results were found between cases with IE with or without rheumatic manifestations. Also, although patients with rheumatic manifestations had more embolic complications, the inhospital mortality rate in patients with rheumatic manifestations was not significantly different from that of the rest of the patients. The present study supports the claim that rheumatic complications are frequent in patients with clinically definite IE from southern Europe. The presence of musculoskeletal or vasculitic manifestations may be of some help, as warning signs, for the recognition of patients with severe disease who require rapid diagnosis and therapy.

Adolescent↗
PubMed2001

Epidemiology of biopsy proven giant cell arteritis in northwestern Spain: trend over an 18 year period.

OBJECTIVE: In Europe giant cell arteritis (GCA) is more common in Scandinavian countries than in southern regions. Epidemiological studies on GCA in other more distant countries have indicated a progressive increase in incidence. A regular cyclical pattern in incidence of GCA over 20 years has been reported in Olmsted County (Minnesota, USA). In contrast, no cyclical fluctuation has been recently reported in Sweden. To investigate further the epidemiology of GCA in southern Europe the trend in incidence and fluctuations of this vasculitis over 18 years in the Lugo region of northwestern Spain were examined. METHODS: A retrospective study of biopsy proven GCA diagnosed between 1 January 1981 and 31 December 1998 at a single hospital for a well defined population of almost 250 000 people. Annual incidence was calculated for the whole group of patients and for men and women separately. Monthly variations, annual peaks of incidence, and trend in the incidence of biopsy proven GCA with and without polymyalgia rheumatica (PMR) were also examined. RESULTS: One hundred and sixty one Lugo residents were diagnosed with biopsy proven GCA between 1981 and 1998. The average annual incidence for the population aged 50 and older was 10.24/100 000 (men 11.00/100 000, women 9.57/100 000). A progressive increase in the incidence in both men and women was seen. In men there was an annual increase of 8% (95% CI 4% to 13%; p<0.0001). In women the annual increase was 11% (95% CI 5% to 17%; p<0.0001). The overall annual increase for men and women was 10% (95% CI 6% to 14%; p<0.0001). No seasonal pattern or peaks in the incidence were seen. During the period 1981-94 GCA was more common in men than in women. In contrast, during the last years of study the increase in incidence was higher in women. In women the annual ratio of incidence of GCA with PMR/incidence of GCA without PMR was generally higher than 1. However, in men the annual ratio was initially 1 but decreased gradually, indicating a progressive decrease in the proportion of men with biopsy proven GCA associated with PMR. CONCLUSION: In northwestern Spain there has been a progressive increase in GCA incidence. As seen in other countries where GCA is more common, during the past few years the increase in incidence has been mainly due to a higher number of new cases in women.

Age Factors↗
PubMed2001

Recreation in coastal waters: health risks associated with bathing in sea water.

STUDY OBJECTIVE: To find out whether bathing in sewage polluted waters implies a danger to bathers' health and to determine the best microbiological indicator to predict the relation between bathing and the appearance of some symptoms. DESIGN: Cohort study. SETTING: City of Santander (north of Spain). PARTICIPANTS: From the people going to four Santander beaches in the period from 1 July to 16 September 1998, a cohort of 2774 persons was recruited who agreed to participate in this study. Of those, 1858 successfully completed a follow up interview conducted in seven days. Respiratory, gastrointestinal, eye, and ear symptoms, and fever occurring during the seven day follow up were recorded. MAIN RESULTS: A total of 136 participants (7.5%) reported symptoms. Visitors reported experiencing symptoms with more frequency than residents. Incidence rates of gastrointestinal, cutaneous and high respiratory tract symptoms were higher in bathers, but the differences were not significant. Total symptoms were related with the amount of total coliforms, faecal coliforms, and faecal streptococci in the water. Gastrointestinal and skin symptoms kept a positive trend with the degree of water pollution by total coliforms in both crude and adjusted analyses. An increased risk was observed in 2500-9999 total coliforms per 100 ml, a figure over the proposed standard, although below the European Union mandatory limit. CONCLUSIONS: The results of this study suggest that total coliforms are the best predictors of the symptoms.

Adolescent↗
PubMed2001

Participation of epidemiologists and/or biostatisticians and methodological quality of published controlled clinical trials.

STUDY OBJECTIVE: This study assessed several methodological aspects related to the quality of published controlled clinical trials (CCTs) in relation to the participation of an epidemiologist/biostatistician (E/B). DESIGN: Handsearch of CCTs published in four medical leading journals for 1993-1995. METHODS: Quality variables, abstracted from a review, were related to authors' specialties. Five hundred and ninety four CCTs were identified via a hand search. The department/unit membership was used to attribute authors' specialties. Of 594 CCTs identified, in 127 the authors' specialties could not be known, leaving 467 trials for analysis. RESULTS: E/B participation occurred in 178 trials (38.1%). This participation was more frequent in multicentric, bigger, and in those trials describing any funding agency. These factors were controlled for in the analysis. E/B participation was positively associated with pre-study sample size estimation (OR = 1.5, 95% confidence intervals (CI) 1.0, 2.3), with reporting the dates for starting/ending the study (OR = 2.1, 95% CI 1.4, 3.3), with using an objectively assessed outcome (OR = 2.4, 95% CI 1.2, 4.6) and with the intention to treat principle (OR = 2.0, 95% CI 1.3, 3.0). The overall quality score was higher in trials where E/B participated. CONCLUSIONS: The results suggest that E/B improve the quality (at least of reports) of clinical trials. Given that quality of research is frequently used to evaluate potential sources of heterogeneity between trials, these results are relevant for meta-analysis.

Controlled Clinical Trials as Topic↗
PubMed2001

Predictive factors for renal sequelae in adults with Henoch-Schönlein purpura.

OBJECTIVE: To examine the outcome and risk factors for renal sequelae in an unselected population of adults with Henoch-Schonlein Purpura (HSP). METHODS: Retrospective study of adult patients (> 20 years) with biopsy proved cutaneous vasculitis diagnosed as having HSP seen at a single center between 1984 and 1998. Patients were classified as having HSP according to proposed criteria. Only those patients with a followup of at least 1 year were included in this study of renal sequelae. RESULTS: Twenty-eight patients with a mean followup of 5.5 years fulfilled the inclusion criteria. When the study was concluded, 10 patients (36%) had renal sequelae and 2 (7%) had renal insufficiency. Men outnumbered women. However, neither a previous history of drugs, gender, nor age at disease onset was associated with a higher risk of permanent renal involvement. Patients with hematuria at disease onset or renal involvement during the course of the disease more commonly developed renal sequelae (p < 0.001). The presence of anemia (p = 0.05) at the time of diagnosis and the onset in summer (p < 0.05) were also more common in those with permanent renal involvement (renal sequelae). Patients with relapses had also a higher trend to develop renal sequelae (p = 0.07). All patients who fulfilled more than 2 of these 5 risk factors developed permanent renal involvement. With this model we were able to predict renal sequelae in 8 of the 10 patients who had this complication. The Goodman-Kruskal gamma test value was 0.92 (95% CI 0.78-1.00). CONCLUSION: In unselected adults with HSP, permanent renal involvement (renal sequelae) is not uncommon. Hematuria at disease onset and persistence of renal manifestations during the course of the disease are significant indicators of possible development of renal sequelae. These manifestations plus other features such as onset in summer, anemia at disease onset, or relapses of the disease may predict the development of renal sequelae in most patients.

Adult↗
PubMed2001

Determinants of the interval between the onset of symptoms and diagnosis in patients with digestive tract cancers.

The main objective of this cohort study was to analyze the influence of social factors on the interval from the onset of symptoms to diagnosis in the 217 patients with digestive tract cancer. From the clinical charts, the following information was extracted: date of the beginning of illness, dates of medical attendance, type and date of diagnostic tests, characteristics of the disease (symptoms, stage), and date of treatment. From personal interviews we gathered the data not present in the clinical chart: sociodemographic data, information about other underlying diseases, and variables related to lifestyle. The time periods considered were from onset of symptoms to initial consultation (S-C); from initial consultation to hospital admission (C-H); and from hospital admission to diagnosis (H-D). The information on hospital admission, diagnosis, and treatment was prospectively gathered, whereas data before hospitalization were assessed retrospectively. For statistical analysis, we used Kruskal-Wallis test and Cox regression. Pain was the only predictor associated with a shorter S-C period. Hemorrhage, number of symptoms, and hospital consultation significantly shortened the interval C-H. Both hemorrhage and pain, and an initial visit at private primary care were the independent predictors that decreased the period H-D. In conclusion, sociodemographic factors did not influence healthcare attendance.

Aged↗
PubMed2000

[Role of primary care teams in hospitalization of children under 2 years of age?].

OBJECTIVE: To determine whether the structure of primary care teams on carrying out the healthy child health programme leads to a drop in the risk of admission to hospital of children under two, in comparison with the traditional clinic or out-clinic health system. DESIGN: Case-reference epidemiological study. CASES: 40% of the children under 24 months admitted to paediatric or neonate floors of the Marqués de Valdecilla University Hospital. Reference: 15% of the recently born children alive in this hospital. Information was gathered through face-to-face interview and by examining health cards. The study ran from April 1995 to May 1996. RESULTS: Children under two monitored habitually by a doctor belonging to a primary care team showed a drop in risk of hospital admission for all clinical diagnoses of 0.57 (95% CI, 0.35-0.93), after adjustment due to various confusion factors such as maternal education, social class, ethnic background, mother's age, mother's tobacco consumption, natural breast-feeding at birth, admission at birth. There was a drop of risk of hospital admission for high temperature without apparent cause in those children monitored habitually by a team doctor (adjusted RR = 0.41; 95% CI, 0.19-0.90). CONCLUSIONS: The advantages of the paediatric health care reform with the structuring of the primary care teams and the accompanying activities performed lead to a drop in the risk of hospital admission of those children under two years old who are habitually monitored by a doctor belonging to a primary care team.

Female↗
PubMed2000

Polymorphism at codon 129 of the prion protein gene is not associated with sporadic AD.

An association between cognitive performance in elderly people and variability in the codon 129 of the prion protein gene (PRNP) has been recently described. The authors analyzed this polymorphism in 278 sporadic AD patients and 268 cognitively normal control subjects. Analyses stratifying by APOE genotype, age, and gender failed to reveal any association between homozygosity for the 129 PRNP methionine or valine alleles and AD.

Age of Onset↗