Search PubMed⌕ Search

Biomedical subjects

Raquel Barba

Publications and source records attributed to Raquel Barba.

13 recordsLinked to original sources
PubMed2006

Venous thromboembolism in patients with renal insufficiency: findings from the RIETE Registry.

BACKGROUND: Current guidelines make no specific recommendations for venous thromboembolism (VTE) treatment in patients with renal insufficiency, but some experts recommend some reduction in heparin dose. METHODS: Registro Informatizado de Enfermedad TromboEmbólica (RIETE) is an ongoing, prospective registry of consecutively enrolled patients with objectively confirmed, symptomatic, acute VTE. In this analysis we retrospectively analyzed the effect of renal insufficiency on the incidence of fatal pulmonary embolism (PE) and fatal bleeding within 15 days of diagnosis. RESULTS: Up to March 2005, 10,526 patients with acute VTE were enrolled in RIETE, of whom 9234 (88%) had a creatinine clearance (CrCl) greater than 60 mL/min, 704 (6.7%) had a CrCl 30 to 60 mL/min, and 588 (5.6%) had a CrCl less than 30 mL/min. The incidence of fatal PE during the study period was 1.0%, 2.6%, and 6.6%, respectively. Fatal bleeding occurred in 0.2%, 0.3%, and 1.2% of the patients, respectively. On multivariate analysis, patients with a CrCl less than 30 mL/min were independently associated with an increased risk for fatal PE and fatal bleeding. In addition, initial diagnosis of PE, immobility for 4 days or more, cancer, and initial therapy with unfractionated heparin were independent predictors of fatal PE; whereas immobility for 4 days or more and cancer were independent predictors of fatal bleeding. CONCLUSIONS: Patients with VTE who have renal insufficiency had an increased incidence of both fatal PE and fatal bleeding, but the risk of fatal PE far exceeded that of fatal bleeding. Our data support the use of full-dose anticoagulant therapy, even in patients with a CrCl less than 30 mL/min.

Aged↗
PubMed2006

Deep vein thrombosis and pulmonary embolism: the same disease?

The clinical characteristics and 3-month clinical outcome of 7,664 patients with acute deep vein thrombosis(DVT), 3,968 patients with pulmonary embolism(PE), and 2,287 with signs of both DVT and PE were compared. As compared to patients with DVT signs, PE patients were more commonly females, older and had less often cancer, prior VTE or recent surgery. By contrast, they had more often chronic lung disease,chronic heart failure or renal insufficiency. Patients with both DVT and PE signs were also more commonly females and older than those with only DVT signs, but they had more often a prior episode VTE, cancer, chronic lung disease, chronic heart failure or renal insufficiency. As for the 3-month clinical outcome,patients with PE signs had a significantly higher incidence of major bleeding, recurrent PE, fatal PE and overall death than those with only DVT signs,but a lower incidence of recurrent DVT. Besides, patients with DVT and PE signs had an even worse clinical outcome.

Age Factors↗
PubMed2006

Advice from a medical expert through the Internet on queries about AIDS and hepatitis: analysis of a pilot experiment.

BACKGROUND: Advice from a medical expert on concerns and queries expressed anonymously through the Internet by patients and later posted on the Web, offers a new type of patient-doctor relationship. The aim of the current study was to perform a descriptive analysis of questions about AIDS and hepatitis made to an infectious disease expert and sent through the Internet to a consumer-oriented Web site in the Spanish language. METHODS AND FINDINGS: Questions were e-mailed and the questions and answers were posted anonymously in the "expert-advice" section of a Web site focused on AIDS and hepatitis. We performed a descriptive study and a temporal analysis of the questions received in the first 12 months after the launch of the site. A total of 899 questions were received from December 2003 to November 2004, with a marked linear growth pattern. Questions originated in Spain in 68% of cases and 32% came from Latin America (the Caribbean, Central America, and South America). Eighty percent of the senders were male. Most of the questions concerned HIV infection (79%) with many fewer on hepatitis (17%). The highest numbers of questions were submitted just after the weekend (37% of questions were made on Mondays and Tuesdays). Risk factors for contracting HIV infection were the most frequent concern (69%), followed by the window period for detection (12.6%), laboratory results (5.9%), symptoms (4.7%), diagnosis (2.7%), and treatment (2.2%). CONCLUSIONS: Our results confirm a great demand for this type of "ask-the-expert" Internet service, at least for AIDS and hepatitis. Factors such as anonymity, free access, and immediate answers have been key factors in its success.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Evolution of cognitive impairment after stroke and risk factors for delayed progression.

BACKGROUND AND PURPOSE: Cognitive decline occurs in approximately 30% of stroke patients. Acute risk factors have been identified, but long-term risk has not been examined in large samples. The purpose of this research was to determine factors associated with the progression of cognitive impairment after stroke. METHODS: Consecutive stroke patients (193) without previous dementia were assessed 3 months after stroke with an extensive neuropsychological battery and diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition criteria and the Clinical Dementia Rating as normal (139), cognitive decline without dementia (18), or dementia (18 mild, 10 moderate, and 8 severe). After a 24-month follow-up, they were classified as stable, progressing, or improving, according to change in Clinical Dementia Rating score. The determinants of progression of cognitive decline were ascertained by logistic regression analysis of all clinical, neuroimaging, and complementary data. RESULTS: Cognitive status at 24 months was stable in most cases (151; 78.2%), decline progressed in 27 (14%; 6 demented and 21 nondemented), and improved in 15 (7.8%; 7 demented and 8 nondemented). Seven nondemented patients became demented at 24 months, and 5 demented became nondemented. The age (odds ratio [OR], 1.05; 95% CI, 1.01 to 1.1), mental decline before stroke (OR, 1.14; 95% CI, 1.02 to 1.27), number of prescribed drugs (OR, 1.34; 95% CI, 1.05 to 1.72), diastolic blood pressure on admission (OR, 0.96; 95% CI, 0.93 to 0.99), and episodes of hypotension during admission (OR, 7.61; 95% CI, 1.11 to 52.1) were significantly associated with cognitive deterioration. CONCLUSIONS: Cognition is rather stable for 2 years after stroke. Both progression and improvement of cognitive impairment are frequent in demented patients. Age, previous cognitive decline, polypharmacy, and hypotension during admission are risk factors for progression.

Aged↗
PubMed2004

[Venous thromboembolism in patients with neurosurgical process or stroke. A prospective analysis from the RIETE registry].

BACKGROUND AND OBJECTIVE: We studied the characteristics of thromboembolic disease in patients who have suffered a deep venous thrombosis or a pulmonary thromboembolism with the occurrence, two months before, of a neurosurgical process or a stroke. PATIENTS AND METHOD: We analyzed the variables of 57 patients who underwent a neurosurgical operation and those of 86 patients who suffered a stroke. These variables were included in the Computerised Records of Thromboembolic Disease. RESULTS: The average age was of 62.3 (1.9) for neurosurgical and 71.7 (1.5) for stroke patients (p < 0.001). Prophylaxis was previously applied to 31.6% of neurosurgical patients and to 37.2% of patients in the stroke group. Most patients were treated with low molecular weight heparin during the acute phase of the illness. In both groups, 50% of deaths was associated with thromboembolic disease. The proportion of deceases was related to the associated disease and it was significantly higher in the stroke group (18% versus 4.2% in the neurosurgical group, p = 0.028). CONCLUSIONS: In our study, thromboembolic disease was responsible of 50% of deaths. Stroke patients make up a group with a bad prognosis due to their older age and higher frequency of associated pathology; they have a higher risk of death.

Aged↗
PubMed2003

Apolipoprotein E, angiotensin-converting enzyme and alpha-1-antichymotrypsin genotypes are not associated with post-stroke dementia.

There is evidence that indicates the involvement of environmental and genetic factors in the pathogenesis of post-stroke dementia (PSD). In the present work, we examined different polygenic influences on the risk of PSD in a series of stroke patients. We studied 150 consecutive patients evaluated 3 months after suffering acute strokes. All patients were evaluated with a prospective standard protocol and genotyped for vascular disease-associated polymorphisms in the genes coding for apolipoprotein E (including apoE coding and apoE promoter polymorphisms), angiotensin-converting enzyme (ACE) and alpha-1-antichymotrypsin (ACT). Thirty-two cases (21.3%) resulted in dementia 3 months after the stroke. In patients with PSD, the frequency of apoE epsilon 4 (0.08), ACE-D (0.64), ACT-A (0.62) alleles and apoE gene promoter polymorphisms (-491/A, 0.88; -427/C, 0.02) was similar to that of patients without PSD (apoE epsilon 4: 0.10, p=0.79; ACE-D: 0.56, p=0.36; ACT-A: 0.51, p=0.21; -491/A: 0.86, p=1.00; -427/C: 0.08, p=0.29). Our data indicate that PSD is not associated with the genetic risk factors of vascular dementia (VD) that were studied, and that additional factors may contribute to the pathogenesis of PSD.

Adult↗
PubMed2002

Use of neuroleptics in a general hospital.

BACKGROUND: This study investigates the clinical use of neuroleptics within a general hospital in acutely ill medical or surgical patients and its relation with dementia three months after admission compared with control subjects. METHODS: Cases were defined as every adult patient to whom a neuroleptic medication was prescribed during their hospitalization in our Hospital from February 1st, to June 30th, 1998. A control matched by age and sex was randomly selected among patients who had been admitted in the same period, in the same department, and had not received neuroleptics drugs (205 cases and 200 controls). Demographic, clinical and complementary data were compared between cases and controls. Crude odds ratios estimating the risk of dementia in non previously demented subjects compared with the risk in non-demented control subjects were calculated. RESULTS: 205 of 2665 patients (7.7%) received a neuroleptic drug. The mean age was 80.0 +/- 13.6 years and 52% were females. They were older and stayed longer than the rest of the population. Only 11% received a psychological evaluation before the prescription. Fifty two percent were agitated while 40% had no reason justifying the use of neuroleptic drug. Three months after neuroleptic use 27% of the surviving cases and 2.6% of the surviving controls who were judged non-demented at admission were identified as demented. CONCLUSIONS: The most common reason for neuroleptic treatment was to manage agitation symptomatically in hospitalised patients. Organic mental syndromes were rarely investigated, and mental status exams were generally absent. Most of neuroleptic recipients had either recognised or unrecognised dementia.

Journal Article↗
PubMed2002

Previous and incident dementia as risk factors for mortality in stroke patients.

BACKGROUND AND PURPOSE: We sought to determine whether previous or incident dementia increases the risk of mortality after stroke. METHODS: We assessed clinical, functional, and cognitive status in 324 consecutive stroke patients who were followed up for 24 months. Prestroke dementia was diagnosed at admission (Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition criteria) and poststroke dementia 3 months after stroke (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria). The proportion of patients surviving in the groups with and without dementia and the relative risk of mortality were calculated with Kaplan-Meier and with Cox proportional hazards analyses, respectively, for prestroke, stroke-related, and poststroke dementia. RESULTS: Forty-nine patients (15.1% of the total sample) were found to have prestroke dementia. Three months after stroke, 75 cases had poststroke dementia: 50 incident cases (20% of 251 reexamined cases) with stroke-related dementia and 25 already demented before the stroke. After a mean follow-up of 16.1+/-9.9 months, the proportion of survivors was 20.4% in patients with and 72.6% in those without prestroke dementia. After a mean follow-up of 22.1+/-6.7 months, the proportion of survivors was 58.3% in patients with and 95.4% in those without stroke-related dementia. Using multivariate analysis and adjusting for age, sex, hypertension, diabetes, previous stroke, heart disease, and severity and recurrence of stroke, we found the relative risk of mortality associated with prestroke dementia to be 2.1 (95% CI, 1.2 to 3.6), with stroke-related dementia 6.3 (95% CI, 2.3 to 17.3), and with poststroke dementia 8.5 (95% CI, 3.4 to 20.9). CONCLUSIONS: Both previous dementia and incident dementia adversely influence long-term survival after stroke, even after adjustment for other predictors of stroke mortality.

Aged↗
PubMedDate not supplied

Management of patients with acute venous thromboembolism: findings from the RIETE registry.

Guidelines for the treatment of venous thromboembolism (VTE) are mainly based on randomized controlled trials, but a number of patients with VTE are excluded from trials due to co-morbidities (i.e., recent bleeding, renal insufficiency, thrombocytopenia, abnormal prothrombin time or pregnancy). Thus, treatment regimens derived from clinical studies may not be suitable for all patient groups. RIETE (Registro Informatizado de la EnfermedadTromboEmbólica) is a Spanish registry of consecutively enrolled patients with objectively confirmed, symptomatic acute VTE. We compared the clinical outcome during the first 3 months of therapy of VTE patients with at least one of the mentioned co-morbidities with that in patients without them. Of 6855 patients enrolled up to February 2004, 1635 (24%) had at least one reason to be excluded from clinical trials: recent bleeding (2.6%); renal insufficiency (13.6%); thrombocytopenia (2.5%); abnormal prothrombin time (9.1%) and pregnancy (0.7%). During the 3-month follow-up period the rates of fatal pulmonary embolism (odds ratio: 3.3; 95% CI: 2.5-5.2); minor bleeding (odds ratio: 1.8; 95% CI: 1.3-2.2); major bleeding (odds ratio: 3.1; 95% CI: 2.3-4.1) and fatal bleeding (odds ratio: 4.1; 95% CI: 2.1-8.0) were significantly higher in patients with at least one of these co-morbidities than in the remaining 5220 patients. The clinical outcome was significantly worse inpatients with either recent bleeding, renal insufficiency, thrombocytopenia, abnormal prothrombin time, or pregnancy. The expanding RIETE database of "real-world"outcomes may lead to improved treatment of VTE, especially for those patients not usually included in randomized clinical trials.

Acute Disease↗