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Biomedical subjects

R Moreno

Publications and source records attributed to R Moreno.

At least 91 records · Page 5Linked to original sources
PubMed1999

[Evaluation of an automatic system (MB/BacT) for the isolation of Mycobacterium spp].

BACKGROUND: The study purpose was to evaluate the MB/BacT automated system against Löwenstein-Jensen solid media for the isolation of Mycobacterium species. METHODS: 1,511 specimens were processed from 15/10/96 to 28/4/97. For digestion and decontamination NALC-NaOH was used. Auramine smear was performed and both culture media were inoculated after digestion-decontamination. Inoculation on MB/BacT bottles was performed according to the manufacturer's instructions, apart from a modification in MAS antibiotic supplement with the addition of vancomycin at 1 microgram/ml as final concentraction. Both media were incubated for 40 days at 37 degrees C. RESULTS: In total 101 (6.6%) mycobacteria species were isolated. 78 M. tuberculosis, 14 M. avium, 6 M. gordonae, 2 M. chelonae and 1 M. fortuitum. 98 (6.4%) Mycobacterium spp. were isolated in MB/BacT and 79 (5.2%) were isolated in Löwenstein-Jensen. 22 (1.4%) out of 101 grew only in MB/BacT and 3 (0.2%) out of 101 grew only in Löwenstein-Jensen. Sensitivity in MB/BacT was 97% compared to 78% in Löwenstein-Jensen, this difference was estatically significant (p < 0.001). Contamination rate was 1.8% in MB/BacT and 13.3% in Löwentein-Jensen. The average time to detection of Mycobacterium spp. was 15.9 days in MB/BacT and 22.4 in Löwenstein-Jensen. CONCLUSIONS: We believe that MB/BacT is a good system for rapid and reliable detection of Mycobacterium spp.

Automation↗
PubMed1999

[Ambulatory management of chronic obstructive pulmonary disease (COPD): a consensus report].

Based on the Consensus of the Chilean Respiratory Society, this article summarizes the main topics of the ambulatory management of patients with COPD. The Consensus proposes operative definitions in order to prevent the most frequent conceptual errors, specially those related to the confusion between patients with chronic bronchitis without chronic obstruction and those with COPD. Among the diagnostic criteria, the consensus emphasizes the importance of demonstrating irreversible airway obstruction through spirometry, as well as strategies to the differential diagnosis between COPD and asthma. The Consensus summarizes the therapeutic interventions used in the ambulatory setting, including smoking cessation, bronchodilators, corticosteroids, antibiotics, vaccination, oxygen therapy, respiratory rehabilitation and environmental management. The Consensus emphasizes the importance of patient education in order to involve them in their own management. Some criteria for referral of patients are given and the role of exceptional therapeutical interventions, such as non invasive mechanical ventilation and lung reduction surgery are mentioned. The Consensus states that a significative improvement of the quality of life can be achieved with a proper combination of therapeutic interventions.

Ambulatory Care↗
PubMed1998

Transatrial access to the normal pericardial space: a novel approach for diagnostic sampling, pericardiocentesis, and therapeutic interventions.

BACKGROUND: A nonsurgical means to access the normal pericardial space could provide opportunities for diagnostic sampling and therapeutic interventions. Because there are currently no approved nonsurgical methods to accomplish this, we tested a new approach in large animals. METHODS AND RESULTS: A catheter system was employed in a percutaneous approach from a femoral vein to pierce the right atrial appendage. Pericardial access was confirmed by placement of a radiopaque guidewire visible under fluoroscopy (6 dogs, 13 pigs). In 7 of the pigs, pericardial tamponade, produced by injection of saline or heparinized blood into the pericardial space through this route, was confirmed by fluoroscopy and hemodynamic evidence. The feasibility and safety of this access route were tested with multiple repetitions in all 19 animals. At the end of each of the 17 acute experiments, direct inspection after thoracotomy revealed no hemopericardium, laceration, or bleeding on catheter withdrawal. In 24-hour survival studies performed in 2 of the 6 dogs, the animals exhibited no behavioral signs of discomfort or untoward consequences on recovery from anesthesia. Histology revealed only a small (approximately 1-mm) fibrinous plug at the site of puncture. CONCLUSIONS: The percutaneous approach via the right atrial appendage provides a rapid, safe route to access the normal pericardial space for diagnostic sampling and to alleviate high-volume and low-volume (<200 mL) pericardial effusions. The access route is potentially useful for selective administration of therapeutic agents, growth factors, gene vectors, and cardioactive and vasoactive agents to the heart.

Animals↗
PubMed1998

Determinants of a positive exercise test in patients admitted with acute non-infarct chest pain.

BACKGROUND AND OBJECTIVES: Some patients with suspected unstable angina show ischemia at the exercise treadmill test despite having been medically stabilized. The objective of this study was to determine clinical characteristics predicting a positive exercise treadmill test in patients with suspected unstable angina after medical stabilization. METHODS: In 885 hospitalized patients with medically stabilized unstable angina, the relationship between the result of the pre-discharge exercise treadmill test and clinical characteristics was studied. RESULTS: Mean age was 62+/-9 years and 668 (75%) were male. Exercise test was positive (chest pain and/or ST depression > or =1 mm) in 288 patients (33%). Univariate analysis showed the following associated with ischemia at the exercise test: male gender (56% vs. 20%, P<0.001 ), diabetes mellitus (41% vs. 31%, P=0.009), previous unstable angina (41% vs. 24%, P=0.001), previous stable angina (44% vs. 30%, P<0.001), previous coronary artery bypass grafting (43% vs. 31%, P=0.043), peripheral artery disease (45% vs. 31%) and progressive angina (55% vs. 31%, P<0.001). Multivariate analysis showed the following as independent predictors of ischemia: male gender (OR=2.25), diabetes (OR=4.12), previous unstable angina (OR=3.89), previous stable angina (OR=3.74) and progressive angina (OR=4.05). CONCLUSIONS: In patients with suspected unstable angina, after medical stabilization: (1) the exercise treadmill test is positive in one-third of cases; (2) male gender, diabetes, previous angina (unstable and stable) and progressive angina are independent predictors of ischemia.

Acute Disease↗
PubMed1998

Predictors of multivessel disease in cases of acute chest pain.

BACKGROUND: Patients with unstable angina not showing ischemia at the exercise treadmill test after medical stabilization usually have a low-risk coronary anatomy. However, some of them have multivessel disease, and it is not known what characteristics are associated with the extension of the coronary artery disease in this subset of patients. OBJECTIVE: To determine clinical and exertional characteristics associated with multivessel disease in patients with unstable angina and a negative exercise test. METHODS: 312 hospitalised patients with unstable angina and a negative exercise test who had undergone cardiac catheterization were reviewed. The relationship between coronariographic findings (presence of multivessel disease) and clinical characteristics, exercise parameters and left ventricular function was studied. RESULTS: Multivessel disease was present in 97 patients (31%). The following variables were associated with the presence of multivessel disease: age more than 65 years old, previous myocardial infarction, previous admissions because of unstable angina, peripheral artery disease, presence of more than two coronary risk factors, left ventricular dysfunction, functional capacity less than 6 METS, duration of exercise less than 8 min and less than 85% of the maximum heart rate. Multivariate analysis showed, as independent predictors of multivessel disease: previous myocardial infarction, previous admissions because of unstable angina, presence of more than two coronary risk factors and peripheral artery disease. CONCLUSIONS: In patients with medically stabilized unstable angina and a negative exercise test, previous myocardial infarction, previous admissions because of unstable angina, presence of more than two coronary risk factors and peripheral artery disease, but not exercise parameters, are independent predictors of multivessel disease.

Aged↗
PubMed1998

Severe autoimmune hepatitis in a chronic myeloid leukemia patient treated with interferon alpha and with complete genetic response.

A patient with chronic myeloid leukemia (CML) treated with interferon alpha (IFN alpha) and who developed autoimmune hepatitis (AIH) is described. The patient was treated with IFN alpha 2a, a complete cytogenetic response was achieved 5 months later, and this response has lasted now more than 7 years. Autoimmune hypothyroidism appeared at 18 months of treatment, and 1 year later severe type I autoimmune hepatitis developed. To our knowledge this is the first report of such complication in an IFN alpha-treated CML patient.

Autoimmune Diseases↗
PubMed1998

Evaluation of the uniformity of fit of general outcome prediction models.

OBJECTIVE: To compare the performance of the New Simplified Acute Physiology Score (SAPS II) and the New Admission Mortality Probability Model (MPM II0) within relevant subgroups using formal statistical assessment (uniformity of fit). DESIGN: Analysis of the database of a multi-centre, multi-national and prospective cohort study, involving 89 ICUs from 12 European Countries. SETTING: Database of EURICUS-I. PATIENTS: Data of 16,060 patients consecutively admitted to the ICUs were collected during a period of 4 months. Following the original SAPS II and MPM II0 criteria, the following patients were excluded from the analysis: younger than 18 years of age; readmissions; acute myocardial infarction; burn cases; patients in the post-operative period after coronary artery bypass surgery and patients with a length of stay in the ICU shorter than 8 h, resulting in a total of 10,027 cases. INTERVENTIONS: Data necessary for the calculation of SAPS II and MPM II0, basic demographic statistics and vital status on hospital discharge were recorded. Formal evaluation of the performance of the models, comprising discrimination (area under ROC curve), calibration (Hosmer-Lemeshow goodness-of-fit H and C tests) and observed/expected mortality ratios within relevant subgroups. MAIN RESULTS: Better predictive accuracy was achieved in elective surgery patients admitted from the operative room/post-anaesthesia room with gastrointestinal, neurological or trauma diagnoses, and younger patients with non-operative neurological, septic or trauma diagnoses. All these characteristics appear to be linked to a lower severity of illness, with both models overestimating mortality in the more severely ill patients. CONCLUSIONS: Concerning the performance of the models, very large differences were apparent in relevant subgroups, varying from excellent to almost random predictive accuracy. These differences can explain some of the difficulties of the models to accurately predict mortality when applied to different populations with distinct patient baseline characteristics. This study stresses the importance of evaluating multiple diverse populations (to generate the design set) and of methods to improve the validation set before extrapolations can be made from the validation setting to new independent populations. It also underlines the necessity of a better definition of the patient baseline characteristics in the samples under analysis and the formal statistical evaluation of the application of the models to specific subgroups.

Europe↗
PubMed1998

False-positive tests for syphilis associated with human immunodeficiency virus and hepatitis B virus infection among intravenous drug abusers. Valencian Study Group on HIV Epidemiology.

The role of HIV, hepatitis C virus, and hepatitis B virus infections in the production of biological false-positive reactions for syphilis was evaluated in two large samples of intravenous drug abusers and homosexual men attending AIDS prevention centers in Spain. A significantly increased odds ratio (OR) for false-positive tests for syphilis [OR 2.23, 95% confidence intervals (CI) 1.76-2.83] was observed for HIV-seropositive intravenous drug abusers; biological false-positive reactions were also more frequent (OR 1.73, 95% CI 1.30-2.31) among intravenous drug abusers who were hepatitis B virus seropositive but not among those who were hepatitis C virus seropositive (OR 0.90; 95% CI 0.48-1.69). Among homosexuals, the association between HIV and biological false-positive reactions was restricted to subjects who were also intravenous drug abusers, indicating the crucial role of intravenous drug abuse. Only 20.5% of intravenous drug abusers with a previous biological false-positive reaction yielded a false-positive result in their subsequent visit.

Antibodies, Bacterial↗
PubMed1998

[Results of primary angioplasty in patients with multivessel disease].

INTRODUCTION: In patients with acute myocardial infarction treated with primary angioplasty, multivessel disease is associated with a higher mortality. However, if higher mortality is simply due to a higher prevalence of cardiogenic shock or if multivessel disease is an independent risk factor remains unclear. OBJECTIVES: To study if multivessel disease constitute an independent prognostic factor in patients with acute myocardial infarction treated with primary angioplasty, and to ascertain possible mechanisms contributing to the worse prognosis found in these patients. PATIENTS AND METHODS: Between august 1991 and october 1996, 312 patients with acute myocardial infarction were treated with primary angioplasty in our center. Characteristics and in-hospital outcome of patients with or without multivessel disease were compared. RESULTS: Patients with multivessel disease (n = 158; 51%) were older (64 +/- 11 vs 61 +/- 13 years; p = 0.017), less often smokers (60% vs. 76%; p = 0.006) and had a higher prevalence of diabetes (35% vs. 20%; p = 0.007), hypertension (54% vs. 39%; p = 0.012), prior acute myocardial infarction (29% vs. 5%; p < 0.001), prior coronary bypass (2% vs. 0%; p = 0.042) and Killip class IV at admission (19% vs. 8%; p < 0.001). Angiographic success rate was not different in patients with or without multivessel disease (89% vs. 92%; NS). Patients with multivessel disease had a higher in-hospital mortality (21% vs. 7%; p < 0.001), need of revascularization (17% vs. 3%; p < 0.001) and incidence of severe mitral regurgitation, (5% vs. 0%; p < 0.001), second or third atrioventricular blockade (10% vs. 1%; p < 0.001) and severe bleeding (4% vs. 1%; p = 0.089). After excluding patients with Killip class III or IV at admission, mortality was also higher in patients with multivessel disease (9% vs. 2%; p = 0.009). Multivariate analysis showed the following independent risk factors for mortality: age > 65 years, Killip class IV and multivessel disease. CONCLUSIONS: In patients with acute myocardial infarction treated with primary angioplasty, multivessel disease is associated with higher mortality. This is due not only to a higher prevalence of cardiogenic shock at admission, but also to a worse baseline profile, a higher incidence of complications and a more frequent need of revascularization.

Age Factors↗
PubMed1998

Informal consultations provided to general internists by the gastroenterology department of an HMO.

OBJECTIVE: To study the process, outcomes, and time spent on informal consultations provided by gastroenterologists to the primary care general internists of an HMO. DESIGN: Observational study. SETTING: A large, urban staff-model HMO. PATIENTS/PARTICIPANTS: Seven gastroenterologists constituting the total workforce of the gastroenterology department of the HMO. MEASUREMENTS AND MAIN RESULTS: Data on 91 informal consultations were obtained, of which 55 (60%) involved the acute management of a patient with new symptoms or test results, and 36 (40%) were for questions related to nonacute diagnostic test selection or medical therapy. Questions regarding patients previously unknown to the gastroenterology department accounted for 74 (81%) of the consultations. Formal referral was recommended in only 16 (22%) of these cases. As judged by the time data gathered on the 91 consultations, the gastroenterologists spent approximately 7.2 hours per week to provide informal consultation for the entire HMO. CONCLUSIONS: Gastroenterologists spend a significant amount of time providing informal consultation to their general internist colleagues in this HMO. The role informal consultation plays in the workload of physicians and in the clinical care of populations is an important question for health care system design, policy, and research.

Boston↗
PubMed1998

Evaluation of two outcome prediction models on an independent database.

OBJECTIVE: To evaluate the performance of the New Simplified Acute Physiology Score (SAPS II) and the admission Mortality Probability Model (MPM0) in a large independent database, using formal statistical assessment. DESIGN: Analysis of the database of a multicenter, multinational, prospective cohort study, EURICUS-I. SETTING: Eighty nine intensive care units (ICUs) from 13 European areas. PATIENTS: Data of 16,060 patients consecutively admitted to the participating ICUs were collected during a period of 4 months. Following the original SAPS II and MPM0 criteria, the analysis excluded: patients <18 ys of age; readmissions; patients admitted with acute myocardial infarction; burns; and patients in the postoperative period after coronary artery bypass surgery. All patients with a length of stay <8 hrs were excluded from the study to keep comparability between both systems. A total of 10,027 patients were analyzed. INTERVENTIONS: Collection of the first 24 hrs' admission data necessary for the calculation of SAPS II and MPM0 and basic demographic statistics. Vital status at discharge from the hospital was registered. MEASUREMENTS AND MAIN RESULTS: Despite having a good discriminative capability, as measured by the area under the receiver operating characteristic (ROC) curves (SAPS II: ROC = 0.822 +/- 0.005 SEM; MPM0: ROC = 0.785 +/- 0.006 SEM), both models presented poor calibration, with significant differences between observed and predicted mortality (Hosmer-Lemeshow goodness-of-fit tests H and C, p < .0001). Both SAPS II (predicted risk >40%) and MPM0 (predicted risk >30%) overestimated the risk of death. The evaluation of the uniformity of fit of SAPS II and MPM0 demonstrated large variations across the various subgroups of patients. CONCLUSIONS: The original SAPS II and MPM0 models did not accurately predict mortality on an independent large international multicenter ICU patient database. Results of studies utilizing general outcome prediction models without previous validation in the target population should be interpreted with prudence.

APACHE↗
PubMed1998

Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on "sepsis-related problems" of the European Society of Intensive Care Medicine.

OBJECTIVE: To evaluate the use of the Sequential Organ Failure Assessment (SOFA) score in assessing the incidence and severity of organ dysfunction in critically ill patients. DESIGN: Prospective, multicenter study. SETTING: Forty intensive care units (ICUs) in 16 countries. PATIENTS: Patients admitted to the ICU in May 1995 (n = 1,449), excluding patients who underwent uncomplicated elective surgery with an ICU length of stay <48 hrs. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The main outcome measures included incidence of dysfunction/failure of different organs and the relationship of this dysfunction with outcome. In this cohort of patients, the median length of ICU stay was 5 days, and the ICU mortality rate was 22%. Multiple organ dysfunction and high SOFA scores for any individual organ were associated with increased mortality. The presence of infection on admission (28.7% of patients) was associated with higher SOFA scores for each organ. The evaluation of a subgroup of 544 patients who stayed in the ICU for at least 1 wk showed that survivors and nonsurvivors followed a different course. This subgroup had greater respiratory, cardiovascular, and neurologic scores than the other patients. In this subgroup, the total SOFA score increased in 44% of the nonsurvivors but in only 20% of the survivors (p < .001). Conversely, the total SOFA score decreased in 33% of the survivors compared with 21% of the nonsurvivors (p < .001). CONCLUSIONS: The SOFA score is a simple, but effective method to describe organ dysfunction/failure in critically ill patients. Regular, repeated scoring enables patient condition and disease development to be monitored and better understood. The SOFA score may enable comparison between patients that would benefit clinical trials.

Adult↗
PubMed1998

Primary vagally mediated decelerations in heart rate during tonic rapid eye movement sleep in cats.

Rapid eye movement (REM) sleep results in profound state-dependent alterations in heart rate. The present study describes a novel phenomenon of a primary deceleration in heart rate that is not preceded or followed by increases in heart rate or arterial blood pressure and occurs primarily during tonic REM sleep. The goals were to characterize the primary decelerations and to provide insights on the underlying central and peripheral autonomic mechanisms. Cats were chronically implanted with electrodes to record electroencephalogram, pontogeniculooccipital wave activity in lateral geniculate nucleus, hippocampal theta rhythm, electromyogram, electrooculogram, respiration (diaphragm), and electrocardiogram. Arterial blood pressure was monitored from a carotid artery catheter. R-R interval fluctuations were continuously tracked using customized software. The muscarinic blocking agent glycopyrrolate (0.1 mg/kg i.v.) and the beta-adrenergic blocking agent atenolol (0.3 mg/kg i.v.) were administered in alternating sequence with a 90- to 120-min interval. Glycopyrrolate immediately eliminated the decelerations during REM sleep. Atenolol alone had no effect on their frequency. These findings suggest that a change in the centrally induced pattern of autonomic activity to the heart is responsible for the primary decelerations, namely, a bursting of cardiac vagal efferent fiber activity.

Adrenergic beta-Antagonists↗
PubMed1998

Nursing staff in intensive care in Europe: the mismatch between planning and practice.

OBJECTIVE: To test the use of a human resources-based classification of levels of care of ICUs; to evaluate the match between planned vs operative levels of care on a large sample of European ICUs. DESIGN: Analysis of the database of a multicentric, multinational, prospective cohort study, involving 89 ICUs from 13 European areas. SETTING: Database of EURICUS-I. METHODS: Provision of resources was measured as the number of nurses per ICU bed. Use of resources was measured by the daily use of a therapeutic index (nine equivalents of nursing manpower use score, NEMS) at patient level. Work utilization ratio (WUR) indicated the total number of NEMS points actually scored divided by the total possible NEMS score on each ICU. The planned level of care (LOC) or the mean number of patients to be assisted by one nurse (P/N ratio) made available to the unit was derived from the number of nurses and the number of beds in the ICU. The operative LOC or the actual mean number of patients who were assisted by one nurse (P/N ratio) was computed by dividing the number of NEMS points equivalent to the work of three nursing-shifts (46 points) by the mean daily NEMS score at ICU level. Severity of illness was evaluated by the new simplified acute physiology score. Kappa statistics, intraclass correlation coefficients, and interrater percentage of agreement were used to evaluate the reliability of the data collected for total NEMS score. Chi2 statistics and one-way analysis of variance were used when appropriate. MAIN RESULTS: Data of 16,047 patients (74,383 patient-days) admitted to the ICUs were analyzed. With an overall value of 26.5+/-9.3, the mean NEMS score at ICU level varied significantly among European areas. These differences were not explained by the severity of illness of the patients. The mean WUR was 0.73+/-0.29, presenting also significant differences among ICUs and European areas that were not explained by severity of illness. There was a mismatch between planned vs operative LOCs on 68 ICUs (76%); on 65 (73%), the operative LOC was lower than the planned LOC. This loss of resources concerned particularly the 61 ICUs planned to operate at LOC 3. CONCLUSIONS: The use of human resources-based classification of LOCs is an objective method for evaluation of the match between provision and use of resources in the ICU. This study has shown a large mismatch between planned and utilized LOC in a sample of 89 European ICUs. This mismatch, suggesting an important loss of invested resources, was more apparent in the ICUs that were planned to operate at a higher level of care.

Europe↗