Search PubMed⌕ Search

Biomedical subjects

J Merino

Publications and source records attributed to J Merino.

At least 109 records · Page 6Linked to original sources
PubMed1994

[Influence of the place of measurement and of the person who performs it on the control and diagnosis of arterial hypertension].

The use of ambulatory monitorization of blood pressure has shown the importance of the alarm reaction or white coat reaction and its conditioning factors in some patients. The influence of place (medical facility or home) and person who performs the procedure (doctor or nurse) on the taking of blood pressure is studied with regard to degree of control and/or disease diagnosis. The design is descriptive with a cross-section analysis. The sample is made up of 100 people-50 with hypertension and 50 who came to the center for reasons unrelated to blood pressure and were selected at random. Of the results obtained, the findings below are noteworthy. The number of controlled hypertension cases is fewer in the medical consultation (18 percent) or with nursing staff (22 percent) than in the patients' homes, whether the procedure is performed by the doctor (54 percent) or by the nurse (58 percent) (p = 0.000004). In the group of individuals who sought consultation, the number of hypertension cases detected by random measurements is fewer in the medical consultation (66 percent) than by the nursing staff (48 percent) and lowers significantly at home (p = 0.000001), whether taken by the doctor (22 percent) or by the nurse (20 percent). It is confirmed that figures for blood pressure at home are lower than those registered in the consultation, be they taken by the doctor or the nurse. We believe that the elevation in blood pressure is not exclusively attributable to the doctor and suggest that place where the procedure is performed is more important than the person who performs the procedure.

Aged↗
PubMed1994

[Validity of epidemiologic criteria in the detection of hypertension].

We wish to find out the quality of the diagnostic test commonly used in epidemiological studies to detect hypertension, and in so doing, we study the validity of epidemiological criteria in the detection of hypertension (diagnostic test) and compare the diagnostic thresholds of the World Health Organization (WHO) and the Joint National Committee (JNC). Two methods of detection for arterial hypertension are used in this study of 674 people. One is population-based (mobile unit), and the other is opportunistic sampling. (systematic measurements of blood pressure in medical consultations). As a test of certainty, clinical confirmation is performed. The methodology of Haynes and Sackett is used in the validation study. The epidemiological criteria obtains a sensibility of 90.4 percent and a specificity of 94.4 percent with the diagnostic thresholds of WHO, and a sensibility of 97 percent and a specificity of 81.2 percent with those of JNC, which are defined as effective methods of screening in the detection of hypertension. The excess prevalence of HBP obtained using the diagnostic criteria of WHO is 4.5 percent (that is to say of 12.2 percent of the cases of hypertension found by the epidemiological criteria, that figure decreases to 7.7% percent with clinical confirmation). With the JNC criteria, it is 14.5 percent (from 34.1 percent, it goes to 19.6 percent). This excess can be used to adjust numbers found in epidemiological studies to their real values.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Results of 5 campaigns to detect previously unidentified cases of hypertension].

OBJECTIVE: To find the efficacy of two methods of detecting previously unknown hypertension--systematic taking of blood pressure (ST) and the Mobile Unit (MU)--and to evaluate the over-diagnosis of arterial hypertension (AHT) in crossover studies which only use epidemiological criteria (EC). DESIGN: A descriptive study with population and opportunist strategies. An operative MU team attended commercial and work centres within the chosen area. ST looked for AHT in patients attending Health Centre clinics. INTERVENTION: EC in screening, in line with WHO guidelines and clinical confirmation (CC) in the Health Centres. SETTING: MU in the catchment areas of Novelda, Carrús and C. Jardin Health areas. ST in the San Miguel de Salinas and C. Jardin Health Centres. PATIENTS: 1654 people over 19 with the MU and 4138 through ST. RESULTS: Both methods discovered more hypertension in men (MU p = 0.009 and ST p = 0.000) and in the 20 to 39 age group (MU p = 0.000 and ST p = 0.000). EC led to over-diagnosis (5.8% MU and 6.3% ST); greater in men (6.6% and 6.5%) and +/- 60 years old (8.7% and 7.5%). Positive predictive values obtained were 59.8% with MU and 47.4% with ST. CONCLUSIONS: Both methods are useful ways of identifying people suffering hypertension: both young people and men. But CC is essential in order to make a real diagnosis of AHT. Out of every 10 people detected by using EC, only 5 were confirmed by ST and 6 by MU. This information must be borne in mind when evaluating the the prevalence of AHT in epidemiological studies.

Adult↗
PubMed1993

[Indicators of follow-up activities undertaken by an arterial hypertension unit over a 5 year period].

OBJECTIVE: To assess the efficacy and effectiveness of an AHT programme by means of indicators which analyse the coverage, results and attendance. SETTING: AHT unit at the Health Centre in Novelda, Alicante. DESIGN: A quasi-experimental design of internal comparison with temporal series. The years analysed were 1985, '87, '88 and '90. The following were assessed: support, therapeutic compliance, risk level, weight, monitoring, visits per year, therapy, risk factors. PATIENTS: A cohort of 266 hypertense patients (175 women and 91 men). MEASUREMENTS AND MAIN RESULTS: The Unit significantly increased the number of patients being monitored and treated (WHO 46.7% and JNC 9.1%), but never exceeded 60%. Serious risk was eliminated and moderate risk went down (27.7%). Visits to the Centre were reduced by 2.8 per year. Of risk factors, weight did not go down, but hypercholesterolaemia diminished by 48.4%, hypertriglyceridaemia by 9.8%, hyperglycaemia by 4.4%, hyperuricaemia by 7.9% and tobacco addiction by 19.9%. CONCLUSIONS: These figures contain extremely interesting information. They reveal the achievements and difficulties of clinical practice and point to practical strategies.

Adult↗
PubMed1993

[The benefits of auditing clinical histories. Our experience over 5 years].

OBJECTIVE: To evaluate how our clinical records (CR) are filled in and to observe the impact of measures taken to correct faults found over a five-year follow-up period. DESIGN: Three descriptive studies (auditing methodologies) on representative samples of CR selected at random. Four quality indicators were fixed: internal communication (i.e. legibility and comprehensibility), external communication, manageability and the quality of the activity at attendances measured by the SOAP. The optimum standards (OS) were agreed by the team (technique of nominal group). SETTING: "Florida" Health Centre, Alicante. PATIENTS AND OTHERS PARTICIPANTS: Periodic team meetings to analyse results and agree activities. In 1986, N of CR = 367; in 1988, 370; and in 1990, 372. MAIN MEASUREMENTS AND RESULTS: During the follow-up period, the filling-in of all the variables, except the address, the test carried out and blood pressure, improved. But the following did not reach the OS: code, affiliation, origin, instruction, habits, allergies, working activity, socio-economic data, age and gender, family/personal background, test carried out, blood pressure and analytical data. The following all reached the OS: legibility, which went up from 88% to 96.5%, comprehensibility from 62 to 75.3%, external communication from 81 to 88.9%, manageability from 53 to 79.6% and SOAP from 62 to 82.5%. CONCLUSIONS: Auditing allows the level of the filling-in of the CR to be measured. Deficiencies which appear to be due to the design of the record itself can be detected. The efficacy of corrective measures to improve records can also be assessed.

Communication↗
PubMed1993

Simultaneous evaluation of phagocytosis and Fc gamma R-mediated oxidative burst in human monocytes by a simple flow cytometry method.

In this study we describe a fast, simple, and objective flow cytometry method to quantify simultaneously phagocytosis and Fc gamma R-mediated oxidative burst in human monocytes. Peripheral blood monocytes isolated by elutriation were sequentially incubated with 2',7'-dichlorofluorescein-diacetate (DCFH-DA) and sheep erythrocytes opsonized with rabbit IgG (SRBC-IgG), and then analysed by flow cytometry. Two parameters were studied simultaneously in the same cell population: forward scatter modifications (grade of phagocytosis) and fluorescence intensity of DCFH oxidation (index of oxidative burst). We found a statistically significant correlation (r = 0.96274) between the forward scatter increase and the amount of phagocytosis as determined by light microscopy. We also found a significant correlation between the oxidative burst and phagocytosis studied both microscopically (r = 0.7714) and by flow cytometry (r = 0.78056). As the presence of DCFH did not impair monocyte phagocytosis, we conclude that this simple method could be a useful tool in functional studies of monocytes.

Animals↗
PubMed1993

Autoimmune syndrome after induction of neonatal tolerance to I-E antigens.

Neonatal injection of semiallogeneic spleen cells induces a state of specific tolerance to the parental alloantigens, but also the development of an autoimmune syndrome known as host-versus-graft disease (HVGD). The autoimmune features are a consequence of the allogeneic cooperation between persisting alloreactive host T helper type 2 (TH2) cells and donor semiallogeneic B cells. It has been established that I-A alloantigens play a central role in the triggering of this HVGD. Here it was investigated if I-E antigens, which have shown functional differences, regarding autoimmunity and alloreactivity, with respect to I-A antigens, are also able to trigger this autoimmune syndrome. The injection of spleen cells from [B10.A(4R) x B10.A(2R)]F1 (I-E+) hybrid mice into newborn B10.A(4R) (I-E-) mice was accompanied by the establishment of chimerism and also by the development of a characteristic, but moderated, HVGD. The weak intensity of this HVGD is likely due to the moderation of the alloreactive responses induced against I-E molecules. Moreover, the marked increase in the levels of IgE and in the titers of anti-DNA IgG1 antibodies strongly suggest that alloreactive TH2 cells play also a main role in the autoimmune syndrome following tolerization to I-E antigens. Therefore, it is concluded that the I-E and I-A isotypes are functionally similar with respect to the allogeneic cellular interactions that account for the HVGD.

Animals↗
PubMed1993

A prospective study of stroke in young adults in Cantabria, Spain.

BACKGROUND AND PURPOSE: The aim of this study was to determine the incidence, type, and prognosis of stroke in young adults in Cantabria, Spain. METHODS: We investigated prospectively all patients aged 50 years or below who were admitted with the diagnosis of a stroke to the University Hospital "Marqués de Valdecilla" from April 1, 1986, to March 31, 1988. This is the main hospital of the region to which all patients with neurological problems are referred. These patients underwent a complete clinical and laboratory assessment for stroke and had 1-year mean follow-up. RESULTS: The total series included 81 patients. The annual age-specific crude incidence rates of stroke were 17.3 and 10.4 per 100,000 for males and females, respectively. Twenty-four patients (30%) were diagnosed as having nonembolic cerebral infarction, 14 (17%) embolic cerebral infarction, 20 (25%) subarachnoid hemorrhage, 22 (27%) spontaneous cerebral hemorrhage, and one case (1%) cerebral venous thrombosis. Eighteen patients (22%) died within 30 days of the cerebrovascular event, and two others died during the follow-up period. Seventy-nine percent of the survivors recovered and were completely self-sufficient. CONCLUSIONS: The incidence of stroke in the young found in Cantabria is comparable with that in previous studies. The initial hospital mortality was not negligible, but the prognosis among the survivors was favorable.

Adolescent↗
PubMed1993

[A four year study of therapeutical observation of patients with hypertension].

We attempt to quantify compliance with hypotension medication regimens in 620 patients with hypertension at the Centros de Salud (community health centers) of Novelda and Elche (in the province of Alicante) and to assess the impact of a mixed-strategy health education program. The method used to evaluate compliance is the self-communicated interview as indicated by Haynes-Sackett. The intervention consisted of individualized instruction, family support, educational leaflets, and written instructions. Among the results obtained, we emphasize the following. First, 64% completed the treatment as prescribed, 16% stopped taking the medication, and 20% followed the regimen in a sporadic fashion, lack of motivation and forgetfulness being the main reasons cited for the latter. Second, 27% of the patients with hypertension--among them, primarily young people and men--do not visit the center for monitoring. Third, the health education program is responsible for a significant increase in blood pressure measurements and in therapeutic compliance, also reducing the number of drop-outs. Fourth, 26% did not come to the unit at the end of the study period (four years) despite phone calls and house visits as reminders.

Adult↗
PubMed1993

[Validity of four indirect methods which evaluate therapeutic compliance for arterial hypertension].

OBJECTIVES: To validate 4 indirect methods for detecting therapeutic non-compliance in 157 patients in a community health center Centro de Salud "Carrus" in Elche, Alicante. MATERIALS AND METHODS: The methods employed are self related compliance (SC), therapeutic gains obtained, Morinsky-Green Test, and the level of knowledge of Batalla disease (LK). For verification purposes, pills were counted, allowing the formation of 2x2 tables to calculate indices of validity. The statistical analysis employed is the calculation of 95% confidence intervals. RESULTS: SC yields significantly the lowest sensitivity (13.7 +/- 7.9%) and the highest specificity (85.7% +/- 7.5%). The LK presents the highest sensitivity 79.5 +/- 9.3%. SC underestimates non-compliance (32.5%) significantly, and the LK overestimates noncompliance (23.6%). CONCLUSIONS: The LK is a good method for detecting problems of low compliance and SC those of high compliance. It is recommended that both methods should be employed in a systematic fashion in clinical practice. However, the LK and SC cannot be used to calculate prevalences of therapeutic noncompliance in population-based studies.

Antihypertensive Agents↗
PubMed1993

[Undergraduate training in primary health care: 6 years' experience at the University of Alicante].

OBJECTIVE: To assess the opinion of medical students on the teaching offered in the Primary Care context (TOPC). DESIGN: Observational and crossover study. The assessment used an opinion questionnaire. PARTICIPANTS: 296 sixth-year medical students between 1987 and 1992. INTERVENTIONS: The TOPC consisted of four weeks stay in a Health Centre with an eminently practical programme. However this also included hour-long theoretical seminars on the most important Primary Care questions and the student's completion of a research project related to Primary Care. RESULTS: The students expressed satisfaction with the TOPC (average score of 4 out of 5). Moreover this satisfaction increased over the five years (from 3.7 to 4.6, p = 0.0001). They believed the TOPC to be useful (3.6 to 4.7, p = 0.0001) and relevant to their future professional activity (3.1 to 4.6, p = 0.0001). They thought that the tutors were very competent (4 out of 5, with no significant variation) and the Health Centres' teaching facilities suitable (3.8 to 4, with no significant variation). Finally, they considered that TOPC should become a compulsory undergraduate subject (3.9 out of 5). CONCLUSIONS: Medical students give a positive rating to the Primary Care teaching offered and believe it should be integrated into the Medicine syllabus as a compulsory subject.

Adult↗
PubMed1992

The measurement of transforming growth factor type beta (TGF beta) levels produced by peripheral blood mononuclear cells requires the efficient elimination of contaminating platelets.

In recent years there has been an increasing interest in measuring the levels of TGF beta produced by peripheral blood mononuclear cells (PBMC), since its abnormal regulation seems to be involved in several pathological states. Platelet-contamination, a common feature in PBMC populations isolated by the standard Ficoll-Paque method, would theoretically disturb the measurement of the levels of TGF beta produced by mononuclear cells, since platelets represent an important source of this cytokine. In this study, supernatants of PBMC cultures from healthy subjects, either platelet-contaminated or uncontaminated, were assayed for TGF beta activity in three different bioassays. We report that the presence of platelets led in most cases to an important overestimation of the TGF beta levels produced by MNC in the Swiss-3T3 bioassay and in a PBMC proliferation assay. In contrast, in the Mv1Lu bioassay these levels were significantly underestimated, an effect which we attribute to the presence of other platelet-derived growth factors. These results suggest that the elimination of platelets from PBMC cultures is essential if TGF beta production by mononuclear cells is to be studied.

Biological Assay↗
PubMed1992

Self-limited autoimmune disease related to transient donor B cell activation in mice neonatally injected with semi-allogeneic F1 cells.

BALB/c mice injected at birth with 10(8) semi-allogeneic (C57BL/6 x BALB.IgHb)F1 spleen cells develop a lupus-like syndrome in which autoantibodies bear exclusively the donor allotype. We have analyzed the evolution of donor B cell chimerism and the autoimmune manifestations during the first year of life in these mice. Anti-DNA, -histone, and -cardiolipin IgG antibodies as well as circulating immune complexes appeared in the second week of life, reached the highest values around the sixth week, and then progressively dropped to normal values after the sixth month in most mice. The kinetics of the evolution of the autoimmune manifestations, as well as the kinetics of serum donor Ig allotype, were parallel to the kinetics of donor B cell chimerism, which was particularly prominent in the spleens in early weeks of life, and progressively decreased after remission of the autoimmune syndrome. Membrane-proliferative glomerulonephritis, which was followed as the more representative histological abnormality in this model, was particularly evident after 10 weeks of life, but disappeared by the end of the follow-up. Interestingly, when mice with a self-limited disease were re-injected with 10(8) F1 spleen cells i.v., a flare in the serological manifestations was observed. In these re-injected mice a predominance of anti-DNA, IgG1 antibodies bearing exclusively the donor allotype was also observed, as in the early weeks of life.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1992

[Fetal cardiac arrhythmia characterized by Doppler echocardiography].

A fetal arrhythmia was detected in a pregnant woman. Fetal Doppler-echocardiography did not reveal cardiac structural alterations; the Doppler flow velocity recordings at the level of the left ventricular outflow tract revealed the continuous succession of three cardiac cycles: a prolonged cycle (456 +/- 6 ms, mean of five measurements), a medium duration cycle (428 +/- 4 ms) and a short cycle (296 +/- 4 ms) after which the prolonged cycle repeated. Identification of the late ventricle filling phase of the atrial systole in the Doppler flow velocity waveform during the long and medium duration cycles, the detection of the systolic movement of the atrial walls preceding contraction of the ventricle walls during the shortest cycle and the verification that summation of the shortest and longest cycles was inferior to twice the intervening cycle, supported the idea that the arrhythmia was produced by frequent atrial premature contractions (one every two sinus beats). The fetal arrhythmia progressively disappeared during pregnancy until delivery without complications, and the newborn's ECG only revealed sporadic premature atrial contractions.

Adult↗
PubMed1991

Transient T and B cell activation after neonatal induction of tolerance to MHC class II or Mls alloantigens.

The neonatal injection of semiallogeneic F1 spleen cells into newborn parental mice results in the induction of tolerance to the corresponding alloantigen (alloAg) and chimerism. In these F1 cell-injected mice, we have previously observed that this state of specific tolerance is associated with the development of a transient lupus-like autoimmune syndrome. In this study, we show that neonatal injection of mice with spleen cells differing from the host at major histocompatibility complex (MHC) class I, class II, class (I + II), or minor lymphocyte stimulating (Mls) alloAg induced a state of specific tolerance characterized by the absence of alloreactive CTL and/or Th cell responses in the spleen and the thymus of 6- to 12-week-old injected mice. However, in mice rendered tolerant to MHC class II or class (I + II) alloAg, the presence of high levels of IgG1 antibodies, of circulating immune complexes, of anti-ssDNA autoantibodies, and of tissue lesions were transiently observed. In these mice, an increased Ia Ag expression on lymphoid spleen cells was also detected at 1 wk. The elevated production of IgG1 and the overexpression of Ia Ag were almost completely prevented by treatment with an anti-IL-4 mAb. Such manifestations of B cell activation and autoimmunity were not observed in mice neonatally injected with F1 cells differing from the host only at MHC class I Ag. In mice neonatally tolerized to Mls Ag, a transient increase in IgG2a production and an overexpression of Ia Ag were detected without features of autoimmunity, and were prevented by anti-INF-gamma mAb treatment. In mice rendered tolerant to MHC class II, class (I + II), or Mls alloAg at birth, the manifestations of B cell activation were associated with the presence of in vivo-activated alloreactive CD4+ T cells in the spleen--but not the thymus--of 1-wk-old injected mice. Together, these results suggest that in mice neonatally injected with semiallogeneic F1 cells, the process of tolerance induction is not efficient during the early postnatal period, and could allow the maturation and peripheralization of some alloreactive CD4+ T cells, leading to transient B cell activation and, depending on the alloAg, to autoimmunity.

Animals↗
PubMed1991

Autoimmune syndrome after neonatal induction of tolerance to alloantigens: analysis of the specificity and of the cellular and genetic origin of autoantibodies.

BALB/c mice neonatally injected with 10(8) semiallogeneic (C57BL/6 x BALB/c)F1 spleen cells become tolerant to the H-2b alloantigens, but also develop a wide range of autoimmune manifestations characteristic of systemic lupus erythematosus (SLE). Indeed, in these mice, the presence of a hypergammaglobulinaemia, autoantibodies--including anti-ssDNA, anti-platelet, thymocytotoxic and rheumatoid factor antibodies--circulating immune complexes, cryoglobulins as well as renal glomerular deposition of immunoglobulins have been observed. In this study, we have shown that the allogenic effect and B cell chimaerism which characterize these F1 cell-injected mice is associated with the expression of a large spectrum of autoantibodies, including anti-ssDNA and anti-cytoskeleton antibodies, and that these autoantibodies are not multispecific. We took advantage of the fact that, in this model, autoantibodies are exclusively produced by F1 donor B cells to inject newborn BALB/c mice with F1 Xid spleen cells lacking the CD5+ B cell subset. Injection of 2 x 10(8) F1 Xid spleen cells triggers the production of anti-ssDNA as well as anti-BrMRBC antibodies, and these mice developed tissue lesions. Finally, analysis of the VH gene family expressed by monoclonal autoantibodies derived from F1 cell-injected mice showed that they used the 2 largest families J558 and 7183. These results suggest that the allogenic effect and B cell chimerism which characterize the neonatal induction of tolerance to MHC alloantigens is associated with the selective triggering of autoreactive B cells producing monospecific IgG autoantibodies. They also imply that upon stimulation by persisting alloreactive CD4+ T cells, either CD5- B cells are able to produce autoantibodies or autoantibody-producing CD5+ B cells can differentiate from Xid spleen cells.

Animals↗