Search PubMed⌕ Search

Biomedical subjects

P Espinosa

Publications and source records attributed to P Espinosa.

16 recordsLinked to original sources
PubMed2001

The impact of a clinical training unit on integrated child health care in Mexico.

This study had two aims: to describe the activities of a clinical training unit set up for the integrated management of sick children, and to evaluate the impact of the unit after its first four years of operation. The training unit was set up in the outpatient ward of a government hospital and was staffed by a paediatrician, a family medicine physician, two nurses and a nutritionist. The staff kept a computerized database for all patients seen and they were supervised once a month. During the first three years, the demand for first-time medical consultation increased by 477% for acute respiratory infections (ARI) and 134% for acute diarrhoea (AD), with an average annual increase of demand for medical care of 125%. Eighty-nine per cent of mothers who took their child for consultation and 85% of mothers who lived in the catchment area and had a deceased child received training on how to recognize alarming signs in a sick child. Fifty-eight per cent of these mothers were evaluated as being properly trained. Eighty-five per cent of primary care physicians who worked for government institutions (n = 350) and 45% of private physicians (n = 90) were also trained in the recognition and proper management of AD and ARI. ARI mortality in children under 1 year of age in the catchment area (which included about 25,000 children under 5 years of age) decreased by 43.2% in three years, while mortality in children under 5 years of age decreased by 38.8%. The corresponding figures for AD mortality reduction were 36.3% and 33.6%. In this same period, 11 clinical research protocols were written. In summary, we learned that a clinical training unit for integrated child care management was an excellent way to offer in-service training for primary health care physicians.

Child↗
PubMed2000

Multicompartment urea kinetics in well-dialyzed children.

BACKGROUND: We have reported catch-up growth with hemodialysis (HD) of approximately 15 hours/week. Without an equilibrated post-treatment blood urea nitrogen, the variable-volume single-pool (VVSP) model will not account for urea rebound, inflating the estimated HD dose (K(d)t/V). A two-pool model (FVDP) predicts rebound, but requires fixed compartment volumes for the equations to be solvable in closed form, also inflating K(d)t/V. METHODS: We developed an approximate perturbation solution (WKB method) to a variable volume, two-pool (VVDP) model. Estimated model parameters were compared with the results of equilibrated kinetic studies using measured clearance K(d) (N = 17). Once the model was validated, we re-analyzed 292 kinetic studies from our earlier cohort, which was considered well-dialyzed on the basis of growth rates (N = 12, mean annual change in height standard deviation score +0.31, mean follow-up of 26 months). RESULTS: For the VVSP, FVDP, and VVDP models, respectively, the mean errors were (1) K(d)t/V, 0.22 +/- 0.07, 0.29 +/- 0.17, 0.06 +/- 0.07 (ANOVA, P < 0.001); (2) urea distribution volume vol/wt (%), -8.2 +/- 4.2, -9.1 +/- 3.0, -2.2 +/- 3.6 (P < 0.001). Sequential studies confirmed reproducibility, with a coefficient of variation < or = 5%. In the earlier cohort, a comparison of the VVSP and VVDP models yielded the following: (1) K(d)t/V, 1.91 +/- 0.35 vs. 1.76 +/- 0.33 (P < 0.001); (2) normalized protein catabolic rate (nPCR, g/kg/day), 1.56 +/- 0.39 vs. 1.52 +/- 0.38 (P < 0.001); and (3) K(d) (whole blood, mL/kg/min), 4.8 +/- 0.9 vs. 4.4 +/- 0.8 (P < 0.001). CONCLUSION: This VVDP model yields reliable estimates of K(d)t/V and other kinetic parameters using standard blood urea nitrogen sampling. Analysis of patients previously characterized as well-dialyzed on the basis of growth rates clarifies the HD dose needed to sustain normal growth.

Adolescent↗
PubMed1999

Growth during maintenance hemodialysis: impact of enhanced nutrition and clearance.

Growth of children during maintenance hemodialysis has been reported to be uniformly poor, with a mean annual loss of 0.4 to 0.8 SD in height. We adopted an intensive program of closely monitored energy and protein intake with dialysis urea clearances exceeding conventional recommendations. Twelve prepubertal or early pubertal children (aged 7 months to 14 years) were monitored for an average of 2.2 years (range 4 to 81 months) while receiving maintenance hemodialysis. These children received an average of 90.6% and 155.9% of their recommended energy and protein nutritional intake, respectively. With a prescribed urea clearance of 5 mL/kg/min, we achieved a mean single treatment urea clearance normalized for total body water of 2.00, a urea reduction ratio of 84.7%, and an average time of hemodialysis of 14.8 h/wk, all well beyond current guidelines. Over the course of dialysis treatment, the improvement in height SD score was+0.31 SD/y (+0.32 excluding the 2 children treated with recombinant human growth hormone). Normal growth was achieved without overt obesity and was associated with normal pubertal growth spurt. These findings suggest that the combination of increased dialysis and adequate nutrition can promote normal growth in children treated with long-term hemodialysis.

Adolescent↗
PubMed1999

Epilepsy and neurocysticercosis in an Andean community.

BACKGROUND: Taenia solium neurocysticercosis (NCC) has been documented as one of the major causes of epilepsy in developing countries. However, methodological limitations have hindered the evaluation of the epidemiological relationship between cysticercosis and epilepsy at the community level. METHODS: We used the WHO protocol for epidemiological evaluation of neurological disorders to conduct a door-to-door survey among 2723 residents of San Pablo del Lago, an Ecuadorean rural community in which T. solium taeniasis/cysticercosis was known to be endemic. The WHO protocol was complemented by neuroimaging and immunological tests to confirm the diagnosis of this infection. RESULTS: In all 31 people suffering from active epilepsy were detected (prevalence 11.4 per 1000, 95% CI:7.7-15.4); 26 agreed to undergo a computer tomography (CT) examination, and 28 agreed to have blood drawn for serodiagnosis. Fourteen of the 26 (53.8%) had CT changes compatible with NCC and six of the 28 (21.4%) tested positive in the enzyme-linked immunoelectro-transfer blot (EITB) assay. In a seizure-free random sample of this population, 17 of 118 (144 per 1000) subjects examined by CT and 10 out of 96 (104 per 1000) examined by EITB had evidence of this infection. The differences between the epilepsy group and the random sample of the population were statistically significant (OR = 6.93, 95% CI: 2.7-17.5, P < 0.001) for CT diagnosis, but not for EITB results (OR = 2.75, 95% CI: 0.8-7.1, P > 0.12, NS). CONCLUSIONS: These findings confirm that T. solium NCC is a significant cause of epilepsy at the community level in Andean villages of Ecuador. It is important to initiate effective public health interventions to eliminate this infection, which may be responsible for at least half of the cases of reported epilepsy in Ecuador.

Adolescent↗
PubMed1999

A clinical training unit for diarrhoea and acute respiratory infections: an intervention for primary health care physicians in Mexico.

In Tlaxcala State, Mexico, we determined that 80% of children who died from diarrhoea or acute respiratory infections (ARI) received medical care before death; in more than 70% of the cases this care was provided by a private physician. Several strategies have been developed to improve physicians' primary health care practices but private practitioners have only rarely been included. The objective of the present study was to evaluate the impact of in-service training on the case management of diarrhoea and ARI among under-5-year-olds provided by private and public primary physicians. The training consisted of a five-day course of in-service practice during which physicians diagnosed and treated sick children attending a centre and conducted clinical discussions of cases under guidance. Each training course was limited to six physicians. Clinical performance was evaluated by observation before and after the courses. The evaluation of diarrhoea case management covered assessment of dehydration, hydration therapy, prescription of antimicrobial and other drugs, advice on diet, and counselling for mothers; that of ARI case management covered diagnosis, decisions on antimicrobial therapy, use of symptomatic drugs, and counselling for mothers. In general the performance of public physicians both before and after the intervention was better than that of private doctors. Most aspects of the case management of children with diarrhoea improved among both groups of physicians after the course; the proportion of private physicians who had five or six correct elements out of six increased from 14% to 37%: for public physicians the corresponding increase was from 53% to 73%. In ARI case management, decisions taken on antimicrobial therapy and symptomatic drug use improved in both groups; the proportion of private physicians with at least three correct elements out of four increased from 13% to 42%, while among public doctors the corresponding increase was from 43% to 78%. Hands-on training courses thus seemed to be effective in improving the practice of physicians in both the private and public sectors.

Acute Disease↗
PubMed1998

The quality of private and public primary health care management of children with diarrhoea and acute respiratory infections in Tlaxcala, Mexico.

In Tlaxcala, Mexico, 80% of the children who died from diarrhoea or acute respiratory infections (ARI) in 1992-1993 received medical care; in more than 70% of cases it was provided by a private general practitioner (GP). The present study evaluated the quality of case management by private and public GPs to children under five years of age with diarrhoea and ARI. During the clinical observation, the treatment and counselling given to the mother were assessed with the WHO guidelines as reference standard. A total of 41 private and 40 public GPs were evaluated for the management of diarrhoea, and 59 private and 40 public GPs for the management of ARI. For diarrhoea, half of the private GPs gave inadequate rehydration therapy, 63% gave incorrect advice on diet, 66% and 49% made an incorrect correct decision in the prescription of antimicrobial and symptomatic drugs, respectively. Public GPs generally performed better in diarrhoea management: 7% gave inadequate rehydration therapy, 13% gave wrong advice on diet, 3% made a wrong decision in the prescription of symptomatic drugs and 28% gave a wrong decision in antimicrobial prescription. In the management of ARI, 66% and 58% of private GPs made a wrong decision in the prescription of antimicrobial and symptomatic drugs, respectively, compared to 30% and 20% of public GPs, respectively. Counselling to the mother given by both private and public GPs was considered inadequate in most cases of diarrhoea and ARI. These results clearly show that private doctors, as important providers of medical care, need to be included in the strategies to improve the quality of care of children with diarrhoea and ARI. Future research needs to address the determinants of the clinical practice of private doctors in countries like Mexico.

Child↗
PubMed1992

Enterotoxigenic and necrotizing Escherichia coli in human diarrhoea in Spain.

Enterotoxigenic Escherichia coli (ETEC) strains of serotype 0153: K-:H45 CFA/I+ STa+ were associated with two outbreaks of neonatal diarrhoea that occurred in two different hospitals of Madrid, in one of which several children died. Two other outbreaks were associated with ETEC strains of serotypes 0159: K-:H21 (LT+) and 0159: K-:H4 (LT+ STa+) without CFA/I and CFA/II colonization factors. Necrotizing E. coli (NTEC) strains of serotype 06:K13, producing the cytotoxic necrotizing factor CNF1 and alpha-haemolysin, were also associated with two outbreaks of neonatal diarrhoea that occurred in a hospital in Madrid and in a hospital in Talavera de la Reina. The results of the characterization of some ETEC and NTEC strains isolated from sporadic cases of diarrhoea are also discussed.

Adult↗
PubMed1986

Field evaluation of enzyme-linked immunosorbent assay for the serodiagnosis of tuberculosis.

An enzyme-linked immunosorbent assay (ELISA) was evaluated as a serodiagnostic test for active tuberculosis in La Paz, Bolivia. ELISA was compared with sputum smear in 277 persons presenting to the Instituto de Torax and was used for screening in 1,458 military personnel. The test was performed under field conditions on 4-microliter samples of capillary blood obtained by finger prick. ELISA was found to have a sensitivity of 69% and a specificity of 88%. Sputum smear had a sensitivity of 79% and a specificity of 100%. ELISA was found to have undiminished sensitivity and specificity in patients who were sputum-negative, and the two tests could be combined to achieve a sensitivity of 92% and specificity of 88%. Positive and negative predictive values were highest for populations with tuberculosis prevalences in the range of that seen among patients presenting to the Instituto de Torax in Bolivia, but ELISA also led to the diagnosis of tuberculosis in 5 of 1,458 soldiers tested in the screening program.

Adolescent↗
PubMed1976

[Not Available].

Explore the source record for details and available documents.

Greek World↗
PubMedDate not supplied

Attempts to establish phage typing as an epidemiological marker for Salmonella enteritidis.

The notable increase in the number of Salmonella enteritidis strains seen in Spain in recent years (from 27.10% in 1980 to 66.36% in 1985) makes it necessary to find an additional epidemiological marker for this serotype. Phage typing was considered because of its discriminatory capacity toward other Salmonella serotypes. Wild and lysogenic bacteriophages were sought for a set of autochthonous bacteriophages. Our set consisted of 6 bacteriophages, 5 wild and 1 lysogenic. When tested on 1,500 selected strains, they produced 9 different phage types. The most abundant phage types were A (74.66%) and B (19.73%). The percentage of non-typable strains was low: only 1.4% from a total of 1,500 strains failed to produce lysis with our set. This reflects the high typability of the bacteriophage set proposed.

Bacteriophage Typing↗
PubMedDate not supplied

[Isolation of Mycobacterium tuberculosis with primary resistance to chemotherapeutic agents in patients with HIV infection].

BACKGROUND: To evaluate the resistance of Mycobacterium tuberculosis in subjects with simultaneous infection by the human immunodeficiency virus. METHODS: Isolation of Mycobacterium tuberculosis was carried out in a University hospital over a period of 7 years with selection of those corresponding to subjects with HIV infection. The isolation of Mycobacterium tuberculosis with resistance to one or more chemotherapeutic drugs was identified and is described herein. RESULTS: A total of 287 subjects were identified having tuberculous disease, 39 (13.59%) of them presented a simultaneous infection by the human immunodeficiency virus. In 4 of the latter (10.26%) Mycobacterium tuberculosis resistant to one or more chemotherapeutic drugs was isolated with the most frequent resistance being to isoniazide (3/4). CONCLUSIONS: A high degree of diagnostic suspicion must be maintained in patients with the human immunodeficiency virus with respect to tuberculosis, not only because of frequent endogenous activation but also because of the danger of in-hospital transmission. The possibility of resistance makes systematic antibiograms in these cases advisable. In these patients recommendations regarding treatment should be followed avoiding shortened or simplified therapeutic periods which have occasionally been demonstrated as ineffective.

Adult↗
PubMedDate not supplied

Determination of tin in canned fruits and vegetables by atomic absorption spectrometry and liquid-liquid extraction.

A method was developed for the determination of tin based on the extraction of its 5,5'-methylenedisalicylohydroxamic acid complex with 1.09M isobutyl methyl ketone in tributyl phosphate. After the samples were treated with nitric and hydrochloric acid, the aqueous phase was made to 0.05M in perchloric acid. When the ratio of aqueous phase to organic phase was 4:1 (v/v), the detection limit and the relative standard deviation (n = 7, 50 micrograms tin) were 0.20 microgram/mL and 0.9%, respectively. The proposed method was applied to the analysis of tin in canned fruits and vegetables. The results were in good agreement with those obtained by the phenylfluorone method.

Food Preservation↗
PubMedDate not supplied

[Critical reading in selected groups of medical students].

BACKGROUND: The shaping of professionals with a critical outlook in their field of endeavor is a goal of some educational institutions in our country. However, little participation from the students is demanded in our medical schools and this probably interferes in the development of skills for critical reading. OBJECTIVE: To evaluate critical reading in medical students with high scholastic achievement as a function of years of medical training. MATERIAL AND METHODS: We studied three groups of medical students who were homogeneous in regard to scholastic achievement (their mean was 9 or higher in a scale of 10). The groups were in the first, third and fifth year of their medical training (N was 24, 15 and 12 respectively). Two homogeneous groups of low achievers (mean of 7 or less in their first year of training with N of 20 and 16) were also included as contrast groups (no homogeneous groups of low achievers were present in higher years). The test applied was elaborated by us and has been validated. It evaluates reading comprehension (30 items) and interpretation (40 items) of medical information with questions to be answered true/false/don't know and which are scored -1 (incorrect), zero (don't know) or 1 (correct). The scores were analyzed using non-parametric techniques. We consider reading interpretation as a capacity better representing critical reading. RESULTS: In the three groups of high achievers, comprehension was the same (median of 26 out of a maximum of 30) and interpretation ranged from 21.5 to 23 with no group differences (Kruskal-Wallis test). The high achievers had significantly higher scores in reading and interpretation than the low achievers (U test p < 0.01). There was also a consistent higher score of comprehension over interpretation in the five groups (chi square of proportions p < 0.01) but the association of comprehension and interpretation was present only in three groups (high achievers in 1st and 3d year and low in 1st with correlations of Spearman ranging from 0.43 to 0.56). CONCLUSIONS: We were unable to detect any significant difference of years of medical training in the ability to comprehend or interpret medical information. We were able to detect differences in these abilities between high and low achievers.

Educational Measurement↗