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Biomedical subjects

P Torre

Publications and source records attributed to P Torre.

67 records · Page 4Linked to original sources
PubMedDate not supplied

[Accident and emergency department inappropriate utilization. An evaluation with explicit criteria].

BACKGROUND: Several studies have shown a growth in the number of visits to accident and emergency (A&E) hospital departments with a high proportion of inappropriate utilization. Methods to identify improper use based on implicit criteria limit the comparisons between hospitals. The aim of this study is to know the proportion of inappropriate attendance's in an A&E department and their associated factors, using a method with objective criteria. METHODS: An instrument based on diagnosis-independent explicit criteria was used to identify inappropriate visits in a random sample of 1845 14-year-old greater patients attended to A&E medical services, and the factors associated with improper demand were analysed. RESULTS: The proportion of inappropriate attendance's was of the 26,8% (495/1. 845). The unadjusted analysis show that the smaller age, absence of comorbidity, spontaneous visit and some diagnostic groups (diseases of the skin, muscle-skeletal, mental, and bad defined symptoms) were associated to a greater proportion of improper use. Upon adjusting the variables through logistics regression, the age, associated pathology, the spontaneous attendance's and diagnostic groups, maintained the association with improper use, but other variables as woman gender, and night hours were also associated to inappropriate utilization. CONCLUSIONS: At least the fourth part of the attendance's in the A&E medical services do not require urgent attention. Inappropriate utilization is associated to characteristic of the patient and the attended process.

Adult↗
PubMedDate not supplied

The effects of early lead exposure on auditory function in rhesus monkeys.

Thirty-one female rhesus monkeys were randomly assigned to three lead exposure conditions (none, birth to 1 year, and birth to 2 years). Blood lead levels were maintained at 35-40 microg/dl beginning shortly after birth and continuing for 1 or 2 years postnatally. Auditory function was assessed in these monkeys at least 1 year after exposure to lead. The outcome measures included tympanometry to assess middle ear function, otoacoustic emissions (OAEs) to assess cochlear function, and auditory brainstem-evoked responses (ABRs) to assess the auditory nerve and brainstem pathways. There were no significant differences among the three experimental groups for any of the tympanometric variables measured suggesting no effect of lead exposure on middle ear function. Suprathreshold and threshold distortion product OAEs (DPOAEs) were comparable among the three groups. Finally, the auditory-evoked response at levels from the auditory nerve to the cerebral cortex did not significantly differ as a function of lead exposure. The lead exposure in this study had little effect on auditory function.

Acoustic Impedance Tests↗
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Aging and middle ear function in rhesus monkeys (Macaca mulatta).

This study provided tympanometric data on rhesus monkeys (Macaca mulatta) and more support for this monkey as a good model for human peripheral auditory function. There have been few published reports concerning middle ear function in rhesus monkeys, and these experiments addressed that need. In the first experiment, peak acoustic admittance (Ytm) and ear-canal volume (Vea) were measured in 17 older adult monkeys and 16 younger adult monkeys. In the second experiment, middle ear resonance frequency was measured in eight younger adult monkeys and four older adult monkeys. Overall, peak Ytm, Vea, and resonance frequency were similar for monkeys and humans. Specifically, peak mean Ytm and mean Vea in monkeys were comparable to those values in human children. There was a trend for older monkeys to have decreased peak Ytm and Vea, but these trends did not reach statistical significance. There was a significant sex effect similar to what has been reported in humans. Male monkeys had larger peak Ytm values and larger Vea values compared with female monkeys regardless of age. Finally, there were no significant age or sex effects on resonance frequency.

Aging↗
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Hearing sensitivity in adults screened for selected risk factors.

As a means of partially distinguishing age effects and other risk factors in presbyacusis, hearing thresholds for 56- to 65-year-old participants screened for exclusion of selected risk factors were compared with thresholds for 48- to 55-year-old participants without the same risk factors. Hearing thresholds for both age groups were also compared with age-appropriate International Standards Organization (ISO) norms. Even after screening participants for exclusion of selected risk factors, differences in hearing sensitivity remained across age groups. Across the male and female groups, thresholds were generally better (lower) for 48 to 55 year olds than for 56 to 65 year olds. ISO norms generally underestimated the degree of hearing loss for participants of comparable age in the present study. The underestimation was small at lower test frequencies, was generally greater for men, and was largest at test frequencies above 2000 Hz.

Age Distribution↗
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[Atrial fibrillation and acute ischemic cerebrovascular disease. Study of 500 cases of cerebral infarction and transient cerebral ischemic attacks].

The prevalence of chronic atrial fibrillation (AF) and the clinical features in 151 patients with transient ischemic attacks (TIA) and in 349 patients with cerebral infarct have been analyzed. AF was found in 11.9% of patients with TIA and in 14.9% of patients with cerebral infarct. The difference was not significant (NS). In patients without AF, the carotid artery TIAs represent 70.6% of all TIAs, while the vertebral basilar artery TIAs account for 29.4%. When AF is present, 88.9% of all TIAs belong to the carotid artery and 11.1% to the vertebral basilar artery circulatory system (NS). TIAs lasting less than 10 minutes are 42.1% when AF is not present, while when AF is present they are only 11.1% (p less than 0.001). In patients without AF 79% of TIAs last less than one hour, while in patients with AF the percentage goes down to 38.9% (p less than 0.001). In patients with or without AF, the chronic digitalis therapy before the hospitalization does not affect in any way the occurrence of TIA or cerebral infarct. These results suggest that emboli from the atrium are more likely to cause cerebral infarcts than TIAs and when they cause TIAs more usually they last hours than minutes.

Atrial Fibrillation↗
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[Migraine crisis and neurological focal signs of slow or absent resolution (complicated migraine)].

Sixteen cases of vascular headache of the migraine type are referred in whom marked neurological manifestations occurred in a unilateral distribution as part of a migraine attack ("complicated migraine"). The neurologic disorders observed, in order of frequency, include 10 cases of motor hemiparesis, 3 cases of unilateral cerebellar syndrome, 1 case of sensory-motor hemiparesis and 1 case showing signs of the involvement of the motor nuclei of the bulb. The recovery of the motor, sensory, cerebellar and brainstem defects was very slow (average duration: 44.25 days; mode: 14 days) in twelve cases. Two patients showed residual neurological signs respectively after 1 and 7 years from the migraine attack. The patients histories indicate classic or common migraine with a relatively high frequency (80% of the patients experienced one or more crises per month). The most of cases (75%) were female patients. The patients, at time of the attack of complicated migraine, had a mean age years of 32. In ten cases first-grade relatives suffered from classic or common migraine; in no case was there any report of associated or complicated migraine among the relatives. In 4 of the 16 cases the CT scan showed an area of hypodensity consistent to the region of the brain expected to be suffering in view of the clinical type of neurological defect. The Authors take into consideration the controversial relation between complicated migraine with slow or incomplete resolution of neurologic signs and focal brain ischemia due to atherothrombotic infarct, pointing out that the present state of knowledge prevents the reaching of final conclusions.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

[Ticlopidine and amaurosis fugax: results of treatment in a case with very frequent and typical attacks].

In a 59 years old patient suffering from a non stenotic atheroma of the internal right carotid artery, 12 attacks of "amaurosis fugax" (a.m.) affecting the right eye occurred over a period of 36 days. Ticlopidine at doses of 500 mg and subsequently of 250 mg per day was administered and the attacks of "amaurosis fugax" briskly stopped. In the 8 month period following the occurrence of the last episode of monocular blindness, the patient continued the therapy with ticlopidine and no visual disturbances were more reported. The most likely pathogenetic hypotheses of "amaurosis fugax" in the present case are discussed as well as the possibility that the relation between the attacks of a.m. and the beginning of the treatment with ticlopidine might be fortuitous.

Carotid Artery Diseases↗
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[Prevention and therapy of delirium tremens with tiapride and chlordesmethyldiazepam].

Forty alcohol abusers (with a history of long-time alcohol addiction and mean daily use over 360 grams of alcohol) were treated with tiapride or chlordesmethyldiazepam when stopped their overdrinking. The aim of such pharmacological treatment was both a valuation of effectiveness towards ten target-symptoms and the attempt to avoid the development of a withdrawal syndrome-or, at least, to shorten its course. Chlordesmethyldiazepam resulted to be on the whole more effective than tiapride in dominating all most dramatic symptoms of Delirium Tremens and in avoiding--in a significantly higher number of patients--the onset of a DT syndrome in all its typical features. Moreover, CDDz appeared as a manageable drug and free from important side-effects, and could control symptoms without need of further therapies.

Adult↗
PubMedDate not supplied

[Amaurosis fugax].

A follow up study has been performed in thirteen patients suffering from (amaurosis fugax) (A.F.). From the case material analysis and from the review of the current literature it has been possible to infer that the current pathogenetic hypotheses (cerebral and/or retinal microembolism) of the amaurosis fugax and of the transient ischemic cerebral attacks without ocular symptoms are similar, at least in the most of the cases. In all the cases of amaurosis fugax examined, the clinical symptomatology, the frequency of the episodes and the time required for its complete recovery have been described. Some (risk factors) of cerebrovascular disease, such as hypertension, diabetes mellitus and high plasma levels of cholesterol and triglycerides, have been statistically analyzed using Student's t test and chi-square. As regards other possible risk factors (ischemic heart disease, peripheral vascular diseases, chronic obstructive pulmonary disease) only a statistical frequency analysis has been performed. The results of the anti-platelet therapy in modifying the frequency of the A.F. episodes have been discussed. It has been lastly considered the results of the follow-up study in regard to the prognosis of the A.F.

Adult↗
PubMedDate not supplied

[Hematocrit value and hemoglobin concentration as possible risk factors in non-embolic acute cerebral infarcts].

The hematocrit and the concentration of hemoglobin have been studied in 197 patients (125 men and 72 women) suffering from acute cerebral infarction not due to embolism. The results have been analysed statistically and compared to those of a control group formed by 123 neurologic patients (68 men and 55 women) chosen at random, belonging to the same age range and with no cerebrovascular disease. The hematocrit was significantly higher in the patients who had a cerebral stroke of a non-embolic origin, both males and females, than in the control group, although it was within normal limits. As far as the concentration of hemoglobin is concerned, there is a significant statistical difference between patients with and without cerebral infarction, but only for the female patients.

Adult↗
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[Prevention and therapy of delirium tremens with tiapride].

One hundred chronic alcoholics, who were hospitalized in our ward for neurological disorders directly or indirectly due to a prolonged and continual consumption of alcohol, have been treated with tiapride in doses varying from 600 up to 1200 mg/die. The drug was administered either per os or by injection. 50 of these patients were given, at the same time, graded doses of alcohol per os. The purpose of this study was to analyse the preventive and therapeutical effects of the drug both on ten "target symptoms" examined separately, and on the onset and duration of the alcohol abstinence syndrome. We have noticed that decreasing doses of alcohol, in the first days of hospitalization, were unable to reduce significantly the onset of fits of delirium tremens. Tiapride showed a reasonably good therapeutical activity on some features of the "target symptoms": it shortened the average duration of the symptoms, while it did not prove better than benzodiazepines in inhibiting the onset of the same. The drug was unable to prevent the onset of the abstinence syndrome, and, even if it had a favourable control over the symptoms, it was unable to shorten their duration. The mortality rate was similar to that of other reviews where benzodiazepines, or major drugs acting on the nervous system, were employed. The sedative action of tiapride, even at higher doses, was insignificant, and its hypnotic effect almost absent. No extrapyramidal disorders have been observed, at least up to 1000 mg/die.

Adult↗
PubMedDate not supplied

[Human milk substitutes in Mexican social security services during 1990].

An analysis of the amount, type, trade mark, cost and distribution procedures of milk formulas in the IMSS (Mexican Social Security Institute) and ISSSTE (Social Security Institute for Government Employees) during 1990 is presented. During this year, IMSS purchased 19 million cans of powdered milk (454 g each) with a total expenditure of 20 million U.S. dollars. Mothers have the right to receive 36 cans during the first six months of their baby's life. The type of milk formula distributed included whole milk (53.3%), modified milk (43.2%), and soy derived milk (3.5%). As the number of births during the same period was 706,077, the average of cans per child was 27.1. ISSSTE purchased 3.7 million cans of milk with an expenditure of 6 million U.S. dollars; 42.4 per cent as whole milk, 55 per cent modified milk, and 2.6 per cent soy derived milk. Although this institution should provide 27 cans per child, the average was 46.5. The early age at which powdered milk is introduced to babies and the high cost (in economic and health terms) of this practice indicate the need to review newborn feeding policies within the two major social security agencies in the country.

Costs and Cost Analysis↗