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Biomedical subjects

J Morera

Publications and source records attributed to J Morera.

At least 37 records · Page 2Linked to original sources
PubMed1999

[Identifying asbestos bodies in bronchoalveolar lavage fluid].

UNLABELLED: Asbestos bodies (AB) in respiratory secretions in bronchoalveolar lavage (BAL) identify subjects with lower airway AB content is a potential cause of pleural or pulmonary disease. The precision of this qualitative measure, however, has not been adequately analyzed. OBJECTIVE: To determine the sensitivity and specificity of finding AB in BAL fluid by conventional qualitative cytology in comparison with the quantification of AB in BAL fluid. METHOD: BAL samples from 40 subjects exposed to asbestos (mean age 59.2 years; men/women 36/4) were processed in the following ways: 1) qualitative cytology and 2) quantification of AB in BAL fluid expressed as AB/ml. The concentration of AB in BAL fluid was considered the gold standard (upper limit of normal 1 AB/ml) for determining the precision of qualitative cytology. RESULTS: In 9 of the 40 cases (22.5%) AB was found in BAL liquid cytology, but in only five of them were AB counts greater than 1 AB/ml. AB counts also showed concentrations greater than 1 AB/ml for four patients whose qualitative results were negative. The sensitivity of a qualitative AB-positive finding for identifying subjects with potentially disease-causing AB concentrations was 0.55, while specificity was 0.87. We conclude that a qualitative finding of AB in BAL fluid is adequately specific, but that sensitivity is very low, an indication that AB concentration in BAL should be determined to adequately screen for patients at high risk of developing disease.

Asbestos↗
PubMed1999

Risk factors for lower airway bacterial colonization in chronic bronchitis.

The aim of this study was to determine the prevalence and risk factors for lower airway bacterial colonization (LABC) in stable chronic bronchitis (CB). Forty-one outpatients with CB were enrolled in the study (age 63.8+/-9.1 yrs (mean+/-SD); forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) 62.8+/-11.2; current/former smokers 24/17). All patients had normal chest radiographs and an indication for performing fibreoptic bronchoscopy (pulmonary nodule, remote haemoptysis). The protected specimen brush (PSB) was used for bacterial sampling, and concentrations > or = 1,000 colony-forming units (cfu) x mL(-1) were considered positive for LABC. The repeatability of the procedure in CB was assessed in a random subsample of 18 subjects. A 72.2% quantitative agreement was found in the repeatability assessment of the PSB technique. Positive PSB cultures, obtained in 9 out of 41 (22%) patients, mainly yielded Haemophilus influenzae. The logistic regression model, used to determine which variables were related to colonization, showed that LABC was associated with current smoking (odds ratio (OR) 9.83, confidence interval (CI) 1.16-83.20) and low FVC (OR 0.73, CI 0.65-0.81). Age and FEV1 were not related to LABC. It was concluded that the prevalence of LABC in stable CB is high (22%), and current smoking is an important risk factor.

Bacteria↗
PubMed1999

Analysis of tracheal sounds during forced exhalation in asthma patients and normal subjects: bronchodilator response effect.

PURPOSE: During the past 10 years, the acoustic analysis of breath sounds has been used as a diagnostic tool in patients suffering from obstructive respiratory diseases. Acoustic analysis might be able to monitor the response to bronchodilator therapy in a clinical setting. So far, few studies have been carried out in asthmatic patients. To assess the responses of a sampling of asthma patients to an inhaled bronchodilator (terbutaline) by means of spectral analysis of the tracheal sound performed during forced expiratory maneuvers. MATERIAL AND METHODS: Seventeen nonsmoking asthma patients (9 were male, 8 were female) who had been suffering from the disease for > or = 15 years were included in the study, as were 15 normal subjects (7 were male, 8 were female). The average age (+/- SD) was 56.5 +/- 15.2 years (FVC, 2.7 +/- 0.9 L [63.4%]; FEV1, 1.5 +/- 0.6 L [53.0%]). The tracheal sounds were collected during three forced expiratory maneuvers with a sampling frequency of 5,000 Hz and were analyzed by applying a 16-parameter autoregressive model. RESULTS: The centroid frequency decreased after the bronchodilator was given at different flow segments between 1.2 and 0.4 L/s, with significant changes between 0.6 and 0.4 L/s. CONCLUSIONS: Patients with asthma showed changes in the spectral acoustic analysis frequencies after the administration of a bronchodilator drug (terbutaline) during forced expiratory maneuvers.

Adolescent↗
PubMed1999

[Determination of clostridium perfringens in pork sausages from the Metropolitan area of Costa Rica].

The presence of C. perfringens was analyzed in 75 samples of pork sausages (chorizo, salchichon and bologna), obtained from five processing plants located in the Metropolitan Area of Costa Rica. Previously and after the biochemical identification of the strains, the most probable number (MPN) of C. perfringens per gram of food was determined and it varied from less than 3 to more than 2.4 x 10(5). There were significant statistical differences (p < 0.005) that support the need of employing biochemical tests for confirming C. perfringens in a given food. C. perfringens was present in 92% of the chorizos, in 28% of the bolognas and in 12% of the salchichon. Every positive sample was tested looking for at least one enterotoxigenic strain, using the reverse passive agglutination latex test; 8% of the tested strains were enterotoxigenic and corresponded to chorizo and bologna from one processing plant and chorizo from another plant. The results obtained in this study show that pork sausages, and not just not processed meats, are important as risk factors for food intoxication by C. perfringens.

Agglutination Tests↗
PubMed1998

[The impact of bronchial colonization in the quality of life of patients with chronic, stable bronchitis].

BACKGROUND: The aim of this study was to determine the impact of respiratory function and bacterial colonization of the lower airway on the quality of life of patients with chronic, stable bronchitis (CB). MATERIALS AND METHODS: A series of 41 patients with stable CB was studied (age: 63.8; standard deviation (SD) 9.1 years; FVC% 91.0 (18.9); FEV1% 74.6 (23.7); FEV1/FEC 62.8 (11.2) with normal thoracic radiography. Patients with previous diagnosis of bronchiectasia, bronchial asthma and/or positive bronchodilatory tests (> 15%) were not included in the study. Bacterial growth in a sputum sample of grade 4-5 of the Murray-Washington scale was considered diagnostic of bronchial colonization. Measurement of the quality of life was performed with the Nottingham Health Profile (NHP) and the St. George Respiratory Questionnaire (SGRQ). RESULTS: The patients presented a moderate alteration in their quality of life with scores over 25 in most of the dimensions of the NHP and the SGRQ. In 9 out of 41 cases (22%), the sputum cultures demonstrated bronchial colonization with the most frequently isolated bacterias being Haemophilus influenzae and Moraxella catarrhalis. Multivariate analysis performed with the quality of life as the dependent variable showed an association between FEV1/FEC1 and the SGRQ score (R2 = 0.18), and energy (R2 = 0.09) and physical mobility (R2 = 0.05) of NHP. CONCLUSIONS: Bronchial obstruction is the main determinant in the quality of life in patients with stable CB. Colonization of the lower airway is observed in 22% of the patients and also influences the quality of life of the patients but to a much lesser extent.

Aged↗
PubMed1998

[Pancoast's syndrome secondary to neck metastasis with normal radiography of the thorax].

Pancoast's syndrome is characterized by pain in the shoulders and upper extremities, Horner's syndrome, bone loss and hand muscle atrophy. Bronchogenic carcinoma is the most common cause, although other neoplasms or lung infection are occasionally responsible. An apical mass on the chest film can be seen in over 90% of cases, although apical pleural thickening is sometimes the only radiographic finding. We describe a patient whose clinical picture was highly suggestive of Pancoast's syndrome but whose chest film was normal. Magnetic resonance imaging disclosed a cervical mass adjacent to the brachial plexus that proved to be cervical metastasis from an unknown primary tumor. We emphasize the need to consider the possibility of a metastatic cervical tumor compromising the brachial plexus in patients with a normal chest X-ray but clinical signs highly suggestive of Pancoast's syndrome.

Adult↗
PubMed1998

nCPAP treatment interruption in OSA patients.

This study has investigated the effect of interrupting nasal continuous positive airway pressure (nCPAP) therapy on 10 obstructive sleep apnoea (OSA) patients (nine male, one female) (53.6 +/- 7.3 years) treated over 2 years. The effect of nCPAP interruption was determined by variations in sleep counts and gasometric values during five consecutive nights. On the first night, the patient used his habitual nCPAP. On the remaining nights, nasal nCPAP was not applied. The apnoea-hypopnoea index (AHI) was found to increase significantly in the second night, attaining a similar level to that of the basal study (2 years ago). SaO2 minimum decreased and PaCO2 increased in the second night with respect to the first night. The interruption of nCPAP therapy in OSA patients treated over a long period of time increases the sleep counts and impairs the gasometric parameters. Consequently, any change in nCPAP time therapy must be checked to avoid negative effects.

Carbon Dioxide↗
PubMed1998

Quality of life in severe chronic obstructive pulmonary disease: correlation with lung and muscle function.

UNLABELLED: Chronic obstructive pulmonary disease (COPD) patients suffer from significant impairment in quality of life (QL), but the variables related to this impairment are not well known. The aim of this study has been to identify physiological parameters related to QL in severe COPD patients undergoing long-term oxygen therapy. MATERIALS AND METHODS: We studied 47 COPD patients using long-term oxygen therapy (43 men/four women, 65.17 SD 8.21 years, 3.17 SD 2.61 years on oxygen). The Nottingham Health Profile (NHP) and activities of daily living (ADL) questionnaire were used to measure QL. Subjective assessment of dyspnoea was performed using a visual analogue scale. The physiological parameters determined were lung function (spirometry, arterial blood gases, lung volumes and carbon monoxide diffusing capacity), muscle function (maximum inspiratory and expiratory pressures, deltoid muscle and handgrip strength), and nutrition status (tricipital skin fold and mid-arm muscle circumference). RESULTS: High ADL (8.32 SD 6.97) and NHP scores (energy 63.3 SD 40.43, pain 35.11 SD 31.56, emotional reactions 43.03 SD 25.13, sleep 51.91 SD 32.75, social isolation 30.64 SD 26.98, physical mobility 49.73 SD 24.93) demonstrated clinically significant QL impairment in the severe COPD patients studied. Stepwise multiple regression analysis found a correlation between lung function and QL. Low FEV1% was associated with impairment in energy, physical mobility and social isolation NHP scores and ADL score (r = -0.3, P < 0.05). RV/TLC also correlated with ADL and social isolation scores (r = 0.3, P < 0.05). Lung function explained 39-45% of the variation in these QL dimensions. QL did not correlate with other lung function parameters, muscle function or nutrition status. CONCLUSION: COPD patients using long-term oxygen suffer from severe QL impairment affecting not only energy and mobility but also emotional reactions, social isolation and sleep. Lung function is related to energy, mobility and social isolation dimensions, but muscle function is unrelated to QL in these patients.

Aged↗
PubMed1998

Role of immunosuppression in the evolution of Legionnaires' disease.

The clinical course of legionella pneumonia in immunosuppressed patients is uncertain. This study was undertaken to determine the clinical evolution of legionellosis on the basis of the immune state and to establish the variables associated with death directly related to legionellosis. The study included 78 patients: 28 with chronic disease who had received immunosuppressive treatment (group 1), 24 with chronic disease without immunosuppressive treatment (group 2), and 26 controls. Inclusion criteria were the occurrence of nosocomially acquired pneumonia, Legionella pneumophila infection, and erythromycin therapy that was initiated within 72 hours following diagnosis. Respiratory and extrarespiratory complications were observed more frequently in groups 1 and 2. Bilateral radiological involvement was most frequent in group 1, and recurrence of legionella pneumonia was observed exclusively in group 1. None of these variables achieved statistical significance. The global mortality of the series was 11.5% (17.9%, 12.5%, and 3.8% in groups 1, 2, and 3, respectively). Variables statistically related to mortality were acute renal failure, shock, and need for mechanical ventilation. Although many of the variables analyzed lacked statistical significance, a trend was seen between complications and basal immunosuppression, as previously suggested.

Aged↗
PubMed1998

Indices of respiratory muscle endurance in healthy subjects.

BACKGROUND: The evaluation of respiratory muscle performance can be described in terms of strength and endurance, the latter usually being measured by means of resistive or threshold inspiratory loads, using devices that are also used for respiratory muscle training. Few authors, however, have published endurance reference values for healthy subjects. To that end, we studied two indices of respiratory muscle endurance in a population of 99 healthy volunteers (50 men, 49 women) divided into five age groups (20-70 years old) applying a modification of the methods of Martyn et al. and Nickerson and Keens. Inspiratory muscle endurance (Tlim) was defined as the time the subject was able to sustain breathing against an inspiratory pressure load equivalent to 80% of the maximum tolerated load (Cmax). Cmax was calculated using a 2-min incremental threshold load. RESULTS: We found that the heaviest inspiratory threshold load tolerated for 2 min and the time a load equivalent to 80% of Cmax (Tlim) could be sustained were not significantly different for male and female subjects. Tlim correlated with Cmax, age, height, and maximum respiratory pressures.

Adult↗
PubMed1998

Sarcoidosis: family contact study.

AIM: To assess the familial aggregation in sarcoidosis in our environment. METHODS: The medical centers of Catalonia (Spain) were approached to identify, retrospectively, patients diagnosed as sarcoidosis from 1986 to 1988. 245 sarcoidosis cases were recorded (annual incidence: 1.36/100,000 inhabitants). Finally, in 1990 a telephone questionnaire was administered to 188 sarcoidosis cases. RESULTS: These cases reported 3,757 familial contacts, 5 of whom had confirmed sarcoidosis. The clinical presentation of familial sarcoidosis was similar to nonfamilial sarcoidosis, only Löfgren syndrome stood out. The prevalence of sarcoidosis among familial contacts was 1.33/1,000. CONCLUSIONS: The familial association is low and corresponds with the low annual incidence in our community.

Adult↗
PubMed1998

Cytology of bronchial biopsy rinse fluid to improve the diagnostic yield for lung cancer.

Sampling techniques are combined during bronchoscopy to increase the diagnostic yield for endobronchial malignant tumours. Bronchial biopsy provides the definitive histological diagnosis in most cases, but accompanying cytological procedures such as washing, brushing, needle aspiration or imprint cytology can increase diagnostic yield. In this prospective study, a different cytological technique, that could enhance the diagnostic yield of bronchoscopy without increasing its time or cost, was tested. Flexible bronchoscopy was performed in 93 patients suspected of having pulmonary neoplasms. Bronchial biopsies were initially placed in a balanced salt solution. When bronchoscopy was finished, all visible tissue fragments were removed and placed in formalin to undergo histopathological examination and the rinse fluid was sent for cytological examination. Washing was performed routinely but no cytological brushing was employed. Eighty-two patients had final diagnoses of malignant neoplasm. In four (4.8%) of these patients, the only positive result came from the cytological examination of the bronchial biopsy rinse fluid. No false-positive results were found. The agreement with the histological results was 81.8%. The addition of bronchial biopsy rinse-fluid examination increased the sensitivity of bronchoscopy from 65.8% to 70.7% (McNemar's p=0.009). The cytological study of bronchial biopsy rinse fluid offers reliable positive results in an additional 4.8% of cases, thus enhancing bronchoscopic diagnostic yield for malignant endobronchial tumours while neither prolonging the procedure nor increasing costs.

Biopsy, Needle↗
PubMed1998

Comparative study of the clinical presentation of Legionella pneumonia and other community-acquired pneumonias.

The aim of this study was to compare the clinical, biological, and radiologic features of presentation in the emergency ward of community-acquired pneumonia (CAP) by Legionella pneumophila (LP) and other community-acquired bacterial pneumonias to help in early diagnosis of CAP by LP. Three hundred ninety-two patients with CAP were studied prospectively in the emergency department of a 600-bed university hospital. Univariate and multivariate analyses were performed to compare epidemiologic and demographic data and clinical, analytical, and radiologic features of presentation in 48 patients with CAP by LP and 125 patients with CAP by other bacterial etiology (68 by Streptococcus pneumoniae, 41 by Chlamydia pneumoniae, 5 by Mycoplasma pneumoniae, 4 by Coxiella burnetii, 3 by Pseudomonas aeruginosa, 2 by Haemophilus influenzae, and 2 by Nocardia species. Univariate analysis showed that CAP by LP was more frequent in middle-aged, male healthy (but alcohol drinking) patients than CAP by other etiology. Moreover, the lack of response to previous beta-lactamic drugs, headache, diarrhea, severe hyponatremia, and elevation in serum creatine kinase (CK) levels on presentation were more frequent in CAP by LP, while cough, expectoration, and thoracic pain were more frequent in CAP by other bacterial etiology. However, multivariate analysis only confirmed these differences with respect to lack of underlying disease, diarrhea, and elevation in the CK level. We conclude that detailed analysis of features of presentation of CAP allows suspicion of Legionnaire's disease in the emergency department. The initiation of antibiotic treatment, including a macrolide, and the performance of rapid diagnostic techniques are mandatory in these cases.

Adult↗
PubMed1997

Chronic obstructive pulmonary disease stage and health-related quality of life. The Quality of Life of Chronic Obstructive Pulmonary Disease Study Group.

BACKGROUND: The American Thoracic Society recently recommended that chronic obstructive pulmonary disease be staged on the basis of the percentage of predicted FEV1. OBJECTIVE: To examine 1) the relation between the american Thoracic Society system for staging chronic obstructive pulmonary disease and health-related quality of life and 2) the effect of self-reported comorbid conditions on health-related quality of life. DESIGN: Cross-sectional study. SETTING: Outpatient clinics of respiratory departments of four hospitals and one primary health care center in spain. PATIENTS: 321 consecutive male patients with chronic obstructive pulmonary disease. MEASUREMENTS: Functional respiratory impairment, FEV1, respiratory symptoms, and health-related quality of life. Respiratory symptoms and health-related quality of life were measured by using the Spanish version of the St. George's Respiratory Questionnaire and the Nottingham Health Profile. RESULTS: Patient scores on the St. George's Respiratory Questionnaire were moderately to strongly associated with disease staging (r = 0.27 to 0.51). Compared with reference values, values for health-related quality of life for patients with stage I disease were substantially higher on the St. George's Respiratory Questionnaire (6 and 34; p < 0.001) and values for impairment were significantly greater in stage 1 patients with comorbid conditions (19 and 36; P = 0.001). At least one concomitant chronic condition was found in 84% of study patients. Comorbid conditions only partly influenced the observed pattern of deterioration of health-related quality of life with worsening stages of disease. CONCLUSION: Staging criteria for chronic obstructive pulmonary disease based on percentage of predicted FEV1 separated groups of patients with varying degrees of impairment in health-related quality of life. Contrary to expectations, even patients with mild disease showed substantially compromised health-related quality of life. Comorbid conditions influenced the relation between chronic obstructive pulmonary disease and health-related quality of life.

Comorbidity↗
PubMed1997

[Analysis of 90 cases of pleural tuberculosis in relation to adenosine deaminase levels].

BACKGROUND: To analyze the adenosine deaminase (ADA) pleural levels and the possibility of a typical pattern of tuberculous pleuritis (TP) in relation to these values. PATIENTS AND METHODS: We analyzed 90 consecutive cases of TP dividend into two groups on the basis of the pleural ADA measurements: group 1 (less than 43 U/I) and group 2 (equal or higher than 43 U/I). We compared: age, sex, tuberculous risk factors, clinic onset and duration, PPD, chest roentgenogram, biochemical (LDH, glucose and proteins) and cytological examination of the pleural fluid, microbiologic studies on sputum, pleural fluid and biopsies, histologic findings of the biopsies, evolution and sequelae after the treatment. RESULTS: 36 patients in the group 1 (40%) and 54 in the group 2 (60%) (p = 0.01). All the parameters were similar in both groups excluding LDH pleural levels, that were higher in group 2. In 20 cases of the group 1, we obtained a second analysis of pleural ADA and we observed in 11 cases (55%) an ADA value above 43 U/I. CONCLUSIONS: We confirmed that ADA pleural level is increased in the majority of our patients with a low initial sensibility of 60%, that can increase with a second determination (72%). ADA activity below 43 U/I cannot exclude the tuberculous aetiology of an effusion and can persist negative in other analyses. The results suggest a response of different chronology without any relation to initial ADA pleural level.

Adenosine Deaminase↗
PubMed1997

[Comparative study of acute and chronic forms of pleural tuberculosis].

To analyze whether a characteristic pattern distinguishes acute forms (symptoms starting no more than one week earlier) and subacute or chronic forms (symptoms lasting more than one week) of pleural tuberculosis (PT) in our practice. Retrospective analysis of 102 cases of PT diagnosed between 1986 and 1992, comparing the findings of case histories, imaging, pleural biochemistry and cytology, microbiology of sputum, pleural biopsy and fluid, anatomy and pathology studies of the biopsy specimens, course of disease, response to treatment and sequelae after one year and a half. Thirty-two patients (31.4%) had acute PT and 70 (68.6%) had chronic forms. LDH levels and the percentage of pleural nuclear polymorphism were higher in acute cases, while the concurrence of systemic involvement and lymphocytic predominance was more often seen in chronic cases. Other data analyzed were similar in both groups. No specific clinical or X-ray profiles or differences in course of disease and response to treatment distinguishes between acute and chronic forms of PT after 7 days. Only LDH levels and cytology results differentiated acute forms and, occasionally, such cases were indistinguishable from pneumonia-like effusion.

Acute Disease↗
PubMed1997

Comparison of radioimmunoassay and enzyme immunoassay kits for detection of Legionella pneumophila serogroup 1 antigen in both concentrated and nonconcentrated urine samples.

We evaluated a commercial enzyme immunoassay (EIA) kit for detection of Legionella pneumophila serogroup 1 soluble antigen by comparing it to radioimmunoassay (RIA), using both concentrated and nonconcentrated urine samples. The sensitivity of EIA was 67.4% in nonconcentrated urine samples and 82.6% in concentrated urine samples. The sensitivity of RIA was 60.9% and 84.8% in nonconcentrated and concentrated urine samples, respectively. Our study indicates that the sensitivity and specificity of EIA are comparable to those of RIA, and that concentrating the antigen by selective ultrafiltration increases sensitivity for both EIA and RIA, with no significant decrease in specificity.

Adult↗