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Biomedical subjects

J Villar

Publications and source records attributed to J Villar.

231 records · Page 13Linked to original sources
PubMedDate not supplied

Methodological issues of randomized controlled trials for the evaluation of reproductive health interventions.

Randomized controlled trials proved the most valid basis for comparing alternative treatment modalities. Unfortunately, the quality of many such trials has not been as high as our patients deserve. We offer here methodological and practical insights to key issues related to the design, implementation, and analysis of randomized controlled trials in obstetrics and gynecology, based on our experience in exploring research hypotheses in this field. Specifically, we present randomization as a method for the prevention of confounding; we discuss the process of randomization and the bias that can be introduced to randomized controlled trials by some popular methods of randomization. The strategies for presenting baseline comparisons and evaluating the impact of a treatment or intervention are also reviewed. We hope to contribute to a more rigorous selection of treatments for our clinical and public health armamentarium.

Bias↗
PubMedDate not supplied

Randomized clinical trials in perinatology in Latin America.

Latin America needs means to obtain accurate figures about its health conditions in order to apply its resources to priority areas. In addition, health actions must be carefully evaluated to assess their impact, operation and costs. The randomized clinical trial (RCT) is the only design able to show the effectiveness of interventions of moderate effect. Also, it gives appropriate information about the expected effect of the interventions and implies an expediate implementation of interventions in the same places where the project has been performed. In a review of RCTs performed in Latin America on perinatal medicine it can be concluded that some of the focus of research is irrelevant to the region and there is not an orientation towards the cooperative solution of predominant problems in the area. It is imperative for researchers, in Latin America to initiate joint activities in order to assess which are the research priorities of the area, to focus their research on these priorities and to join their efforts in collaborative studies.

Health Services Needs and Demand↗
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Cryptococcal peritonitis: report of a case and review of the literature.

We describe a patient diagnosed with AIDS and cirrhosis who had recently suffered a self-limited and non-specific esophageal ulceration. After this, he was hospitalized because of an oral bleeding with fatal evolution, and Cryptococcus neoformans was isolated from ascitic fluid during a routine paracenteses. We have reviewed the literature and, since 1963, only another 10 cases of cryptococcal peritonitis have been reported. A liver disease and not the AIDS (surprisingly, our case is the only report of cryptococcal peritonitis in a subject having both diseases) was the most common underlying disease (72.7%) and was associated with the worst prognosis (only one patient survived). An oral or upper gastrointestinal bleeding was the most common associated circumstance although recent steroid or antibiotic therapy has been also reported. Finally, diagnosis was delayed in many patients. The reasons for these delays are discussed.

AIDS-Related Opportunistic Infections↗
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[Recent determination of cholesterolemia in a healthy adult population from Pamplona].

BACKGROUND: The aims of the study were to assess the proportion of the healthy adult population from Pamplona who were aware of their blood cholesterol levels, and to identify factors associated with this awareness. METHODS: A cross-sectional study was implemented with personal interview to 1066 citizens from Pamplona selected by a random routes sampling procedure. The city was stratified in three urban districts according to the socioeconomic status (high, middle, low). The response rate was 91.8%. The crude odds ratios were computed and a multivariable logistic regression model was fitted using awareness of the blood cholesterol level as the dependent variable, and age, sex, socioeconomic status and smoking as independent variables. RESULTS: 71.2% of the sample (95% CI: 68.3-74.0) reported having some cholesterol determination during the last five years. The multivariate analysis disclosed that non-smokers were aware of their cholesterol levels more frequently than smokers (adjusted OR = 1.38; 95% CI 1.0-1.9), determination of cholesterolemia was also less frequent in individuals under 30 years old and in females (adjusted OR in males: 1.5; 95% CI 1.1-2.0). Regarding socioeconomic status, cholesterol measurement was more frequent in middle and high levels with adjusted OR = 3.2; 95% CI 2.2-4.71 and 1.59; 95% CI 1.11-2.27), respectively. CONCLUSIONS: Cholesterol awareness was more frequent in older individuals and among males. It is remarkable that blood cholesterol measurement was less likely in population groups with worse coronary risk profile (lower socioeconomic status, smokers). This study suggests that there is a need for improving the awareness and control of blood cholesterol levels in healthy adults from Pamplona.

Adult↗
PubMedDate not supplied

Postlaparoscopic cholecystectomy bile leak secondary to an accessory duct of Luschka.

Complications produced by the sectioning of a nonvisualized duct of Luschka are uncommon during laparoscopic cholecystectomy. From 1999 through 2003, we performed 1351 laparoscopic cholecystectomies in our department and observed 2 cases (0.15%) of bile leakage due to duct of Luschka injury. Injury during laparoscopic cholecystectomy is usually produced by an excessively deep plane of dissection and by the anatomical localization of this accessory duct. Clinical symptoms are scarce after duct of Luschka injury. Numerous diagnostic methods have been used to detect these injuries. Nevertheless, careful clinical examination is still of the utmost importance. Noninvasive treatments are usually effective. In patients who present with acute abdomen, as in our cases, or who are not cured by noninvasive treatments, exploratory laparotomy is the best approach. The surgical treatment consists of a lavage of the abdominal cavity, closure of the duct of Luschka, and intraoperative cholangiography to confirm that the biliary tree is intact.

Aged↗
PubMedDate not supplied

[Long-term results of cholesteatoma surgery in children].

In the long-term results, a large percentage of failures of pediatric cholesteatoma surgery (recurrent and residual), as well with the open and closed (ICWT) techniques and motive for the low rates of functional results are a reflection for most authors about the best surgical technique for improving anatomical-functional results. A total of 57 cases of children's cholesteatoma (3-11 years) operated on in a five-year period (1983-1990) with follow-up surgery to 7 years was analyzed statistically. The location of the cholesteatoma in most cases was in the attic and mastoid (72%) with extension to middle ear in 77% and ossicular chain destruction in 80% of cases. In 54% of cases, radical mastoidoepitympanectomy was performed, in 40% mastoidectomy or attico-antrotomy with tympanoplasty and reconstruction of posterior wall with homologous and alloplastic materials, and only in 5.2%, intact canal wall tympanoplasty. Pathological failure (residual + recurrent cholesteatoma) occurred in 17.5% (12.9% with the radical mastoidepitympanectomy, 21% with the reconstructive techniques and 33% with ICWT). The hearing results were better in 17.5% of cases (average 20.2 dB) and hearing loss occurred in 10.5%. At the present time, in most cases the surgical technique used is radical mastoidoepitympanectomy (12.9% of failures).

Child↗
PubMedDate not supplied

[Enzymatic activities of Campylobacter jejuni, C. coli, and C. lari].

Susceptibility to nalidixic acid has been considered for a long time as an important test in the identification of the different species of the genus Campylobacter. However, due to the increasing development of resistance new laboratory tests are needed to carry out an accurate identification to the species level in combination with other typing schemes. We have evaluated the enzymatic activity of 180 Campylobacter spp. strains isolated from clinical specimens performing the Api ZYM system (bioMérieux) in order to assay whether different enzymatic patterns could help to characterize these microorganisms. Thirteen of the 19 enzymatic activities detected by the system (lipase-C14, valine arylamidase, cystine arylamidase, trypsin, chymiotrypsin, alpha-galactosidase, beta-galactosidase, beta-glucuronidase, alpha-glucosidase, beta-glucosidase, N-acetyl-beta-glucosaminidase, alpha-manosidase and alpha-fucosidase) were negative for all the strains tested, whereas 3 enzymes (alkaline phosphatase, acid phosphatase and naphtol-A-S-BI-phosphohydrolase) were detected in 96.6% of the strains. Esterase-C1, esterase lipase-C8 and leucin arylamidase showed a variable reactivity depending on isolates. Enzymatic activity patterns clearly differentiate all the C. lari strains from other Campylobacter species. No significant differences were detected among the enzymatic activities of C. jejuni and C. coli strains. Our study suggests that the Api ZYM system is easy to perform and a valuable method to be applied in the characterization of the campylobacteria as a complement to other biotyping and serotyping schemes.

Anti-Infective Agents↗