Cytomegalovirus (CMV) is the most common viral infection affecting transplant patients, but urina... more Cytomegalovirus (CMV) is the most common viral infection affecting transplant patients, but urinary tract involvement has been rare. Only a few cases of symptomatic ureteritis have been reported in renal transplant recipients. In previous reports the presentation of CMV ureteritis is obstructive nephropathy, often in the absence of systemic illness, or rarely it may also mimic allograft rejection with minimal obstructive symptoms. We describe an additional case of CMV ureteritis in a patient with cutaneous ureterostomy. The unusual clinical presentation with urinary infection symptoms and ureterostomy stoma ulceration constitute a very particular presentation. The increasing report cases with CMV ureteritis suggest an increase of this post-transplant complication.
Anales de medicina interna (Madrid, Spain : 1984), 1993
Levels of cholesterol (CT) and lipoproteins fractions (c-LDL and c-HDL), as well as the atherogen... more Levels of cholesterol (CT) and lipoproteins fractions (c-LDL and c-HDL), as well as the atherogenic index (CT/c-HDL), were assessed in 307 workers of a health center. The study population was classified into groups, based on age and sex and whether they were health (physicians, registered nurses, clinical assistants) or non-health staff. The lipidic profile of the health staff groups was similar to the profile of non-health staff groups of the same age and sex. The percentage of subjects with CT above 200 mg/dl. was significantly higher (79.6 vs 60.9%) (p < 0.05) among the male health staff versus the male non-health staff and lower among the female health staff versus the female non-health staff (34.5 vs 55.5%) (p < 0.05). The differences in the lipidic profile depending on age and sex were confirmed grouping the population on the basis of such criteria. We highlight that all groups, with the exception of the female health staff, had CT levels above those recommended by the W...
Revista portuguesa de cardiologia : orgão oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology, 1995
To evaluate the antihypertensive efficacy at rest and under exercise, and the modifications induc... more To evaluate the antihypertensive efficacy at rest and under exercise, and the modifications induced on the left ventricular mass in patients treated with two different doses of a diuretic. Fifty hypertensive males, mean age 51 years, received during nine months 50 mg/day of chlortalidone and thirteen 25 mg/day for the next nine months. Baseline tension control and echocardiogram and each three months after starting therapy during the two phases of the study were performed. Thickness of the interventricular septum and posterior left ventricular wall in mm, left ventricular mass index in g/m2 were determined. The baseline septum was 15 +/- 3.3 mm, 14.6 +/- 3.1 mm at 9 months and 14.5 +/- 2.9 mm at 18 months, the posterior wall was 14.1 +/- 3.1 mm at baseline, 13.7 +/- 2.9 mm at 9 months and 13.6 +/- 2.9 mm at 18 months. The left ventricular mass index was 153 +/- 45 g/m2 at baseline, 146 +/- 36 g/m2 at 9 months and 144 +/- 39 g/m2 at 18 months. The antihypertensive efficacy at rest an...
BACKGROUND AND OBJECTIVE: Early alterations in retinal microcirculation are observed in most hype... more BACKGROUND AND OBJECTIVE: Early alterations in retinal microcirculation are observed in most hypertensive patients seen in daily practice and the European guidelines consider it is necessary an objective method to quantify these alterations. We have previously ...
Renal replacement therapies which consist of renal transplantation and dialysis are the only trea... more Renal replacement therapies which consist of renal transplantation and dialysis are the only treatment options for patients with terminal renal failure. These therapies have changed the outcome from being fatal to being a chronic disease. Kidney transplantation involves the use of immunosuppressive agents to prevent rejection. Currently, several immunosuppressive agents have shown efficacy, safety, and different costs. The aim was to evaluate the cost-effectiveness of early conversion from tacrolimus to mammalian target of rapamycin inhibitors sirolimus or everolimus versus continuous treatment with tacrolimus among renal transplantat patients in Colombia. We performed systematic literature review to extract data for clinical effectiveness and safety of tacrolimus replacement schemes for immunosuppressive therapy in renal transplantation in adults. A Markov model in TreeAge was developed, simulating the patient&#39;s natural history with renal transplantation. The perspective of the Colombian Health System was used, including only direct costs. The cost-effectiveness ratio and incremental cost-effectiveness ratio were estimated. Deterministic and probabilistic sensitivity analyses were performed. A 5% discount rate was applied in costs and health results. Results for the replacement of tacrolimus to sirolimus are provided. The cost per year of additional life gained for sirolimus was Col$2,441,171.43; the cost for avoided loss was Col$4,014,152.84. The acceptability curve shows that a strategy with sirolimus is the most cost-effective one. This study suggested that the sirolimus strategy is cost-effective in Colombia for patients with renal transplantation using as threshold less than three times the gross domestic product (GDP) per capita of Colombia per life of years gained.
Background. Elderly patients are the fastest growing population requiring renal replacement thera... more Background. Elderly patients are the fastest growing population requiring renal replacement therapy. It has been stated that renal transplantation may be the best treatment option for these patients. However, it has been observed that older patients have a higher mortality rate than those who are younger. Yet the factors that determine posttransplantation outcomes in this population remain poorly defined. The aims of this study were to evaluate the graft and patient survival in kidney transplant recipients who are older than 60 years of age to identify relevant predictive factors. Methods. In this population-based retrospective cohort study of 201 kidney transplantations performed in elderly patients from January 2002 throughout June 2009, we estimated the 1-,3-,and 5-year patients and graft survival rates. We also evaluated the complications and the predictors of poor outcomes. Survival times were analyzed using the Kaplan-Meier method and survival differences assessed with Mantel-Cox log rank-test. We performed a Cox proportional hazards regression models to evaluate the impact of baseline and treatment characteristics on patient and graft survival. Results. Graft and patient survival rates at 1, 3, and 5 years were 76.4%, 71.3%, and 54.3%, and 78.2%, 73.8%, and 56.4%, respectively. Graft survival rates censored for patient death with a functioning graft were 93.1, 92.1, and 89%. Patient survival rates differed between diabetic and nondiabetic subjects at 1, 3 and 5 years (69.5% versus 83.6%; 59.8% versus 72.3%; 43.6% versus 65.7%; P ϭ .008). On multivariate analysis, the factors associated with patients survival were diabetes mellitus (hazard ratio [HR] 2.058, 95% confidence interval [CI] 1.173-3.611, P ϭ .012) and the 1-month serum creatinine value was Ͼ 1.6 mg/dL (HR 2.108 for each point increase, 95% CI 1.521-2.921, P ϭ .000). Furthermore, there was an insignificant trend forward an association between active or past smoker and lower patient survival (HR 1.689, 95% CI 0.937-3.043, P ϭ .08). The main causes of graft loss were patient death (79.5%). acute rejection (6.8%), and chronic allograft nephropathy (5.5%). Conclusion. Renal transplantation can be performed safely and with acceptable outcomes in elderly patients after appropriate clinical evaluation. The grafts show excellent survival albeit that deaths with a functional graft continue to be an important issue.
This study was intended to assess the efficacy and safety of ezetimibe when taken alone or combin... more This study was intended to assess the efficacy and safety of ezetimibe when taken alone or combined with statins in a specialized care setting and under standard clinical practice conditions. A multicenter, retrospective study in patients with dyslipidemia seen in a specialized outpatient clinic and treated with ezetimibe for at least 12 weeks. Patients were divided into three groups: monotherapy, add-on ezetimibe, and initial coadministration. A total of 217 patients (mean age 59 years; 37% ≥65 years) were enrolled. Of these, 61% were women, 21% had type 2 diabetes and 20% had had a previous cardiovascular event so that the lipid lower drug treatment should satisfy the objectives of secondary prevention. Mean change in the monotherapy group (n = 92; mean 41 weeks) included: decrease of LDLc of 28% (P &amp;amp;amp;amp;amp;amp;lt;.001). In the group where ezetimibe was added on to different ongoing statins (n = 94, mean 73 weeks), mean changes was as follows: LDLc -34%, significant change as compared to monotherapy (P &amp;amp;amp;amp;amp;amp;lt; .001). In the group with initial coadministration of ezetimibe with different statins (n = 31; mean 118 weeks), mean change included: LDLc -53% (P &amp;amp;amp;amp;amp;amp;lt; .001). Overall, 64% of patients reached the thereapeutic objective proposed for the Adult Treatment Panel III (ATPIII) for cLDL. In patients with low risk (LDLc &amp;amp;amp;amp;amp;amp;lt; 160 mg/dL), moderate risk (LDLc &amp;amp;amp;amp;amp;amp;lt; 130 mg/dL) and high-very high risk (LDLc &amp;amp;amp;amp;amp;amp;lt; 100-70 mg/dL), the percentage of patients who reached the therapeutic objective was 81%, 64% and 44%, respectively. Under standard clinical practice conditions, ezetimibe appears to be effective and safe for the control LDLc, thus making it possible to reach the therapeutic objectives proposed by the ATP-III in a high number of patients, especially when associated to statins.
The fovea is a spot located in the center of the macula, and responsible for sharp central vision... more The fovea is a spot located in the center of the macula, and responsible for sharp central vision. In this paper a method to detect the macula location and size is presented, as a first step towards the fovea location. Prior to the macula detection, the optic disk size and position is computed. This is performed through the combination of two stages: firstly, a clustering algorithm is used to select the regions which contain the pixels with the highest gray levels. A correlation filter is applied to these regions to compute the approximate center of the optic disk. Then, in order to extract the optic disk, a deformable model which is used. Then, following the morphological properties of the eye, the macula location and size is determined by means of a new correlation filter. Search with this filter is performed in a reduced area of interest, whose size and position is determined by means, again, of the morphological properties of the eye. The algorithm has proven to be fast and accu...
To validate a computer-based method for measuring the calibre of retinal blood vessels, and use i... more To validate a computer-based method for measuring the calibre of retinal blood vessels, and use it to determine the effects of ageing and arterial hypertension on the calibres of these vessels and on their ratio. Digital eye fundus images covering a 50 degrees field and centred on the optic disc were obtained using a 540 nm filter. The boundaries of blood vessels crossing a series of circles concentric with the optic disc were located by an image analysis program; the calibres of vessels crossing the circles perpendicularly were determined automatically, the average arteriole and average vein calibres were calculated, and the arteriovenous ratio (AVR) was calculated as the ratio of these averages. The within-operator, between-operator and within-eye reliability of this method was investigated using images of 30 or 40 eyes; the effects of ageing on average vessel calibres and AVR using both eyes of each of 120 normotensive volunteers aged 10-69 years (60 males, 60 females); and the effects of arterial hypertension using a group of 54 hypertensive patients aged 50.9 +/- 13.9 years. Within-operator, between-operator and within-eye correlation coefficients for AVR were all better than 0.95, and the corresponding coefficients of variation were all better than 3%. The results of Bland Altman approach show a very good agreement. There were no significant differences between right and left eyes or between the sexes in either the normotensive or the hypertensive group. In the normotensive group, vein calibre was almost constant (111 +/- 6 microm), but arteriole calibre and AVR fell significantly from 96 +/- 6 microm and 0.870 +/- 0.046, respectively, in the second decade of life to 85 +/- 4 microm and 0.761 +/- 0.044 in the seventh decade. Arterial hypertension was not associated with changes in vein calibre, but was associated with decreases in arteriole calibre (from 91 +/- 7 microm among normotensive individuals to 84 +/- 2 microm) and AVR (from 0.816 +/- 0.056 to 0.755 +/- 0.027). Age significantly modulated the AVR-reducing influence of hypertension (P = 0.003). The proposed method of measuring retinal blood vessel calibres is reliable and precise (especially for the AVR). In this study, its results confirmed that increasing age and arterial hypertension are both associated with reductions in retinal arteriole calibre and AVR.
Background Timeliness of care is an important dimension of health care quality. The determining f... more Background Timeliness of care is an important dimension of health care quality. The determining factors of less timely care and their influence on the survival of patients with lung cancer (LC) remain uncertain. Aims To analyse the delays in the diagnosis and treatment of LC in our health area, the factors associated with the timeliness of care and their possible relationship with the survival of these patients. Methods A retrospective study was conducted on all patients with a cytohistologically confirmed diagnosis of LC between 1 June 2005 and 31 May 2008. The time delays for consultation (specialist delay), diagnosis (diagnosis delay), and treatment (treatment delay), were analysed, as well as the factors associated with these delays and the influence of the timeliness of care on survival.
Cytomegalovirus (CMV) is the most common viral infection affecting transplant patients, but urina... more Cytomegalovirus (CMV) is the most common viral infection affecting transplant patients, but urinary tract involvement has been rare. Only a few cases of symptomatic ureteritis have been reported in renal transplant recipients. In previous reports the presentation of CMV ureteritis is obstructive nephropathy, often in the absence of systemic illness, or rarely it may also mimic allograft rejection with minimal obstructive symptoms. We describe an additional case of CMV ureteritis in a patient with cutaneous ureterostomy. The unusual clinical presentation with urinary infection symptoms and ureterostomy stoma ulceration constitute a very particular presentation. The increasing report cases with CMV ureteritis suggest an increase of this post-transplant complication.
Anales de medicina interna (Madrid, Spain : 1984), 1993
Levels of cholesterol (CT) and lipoproteins fractions (c-LDL and c-HDL), as well as the atherogen... more Levels of cholesterol (CT) and lipoproteins fractions (c-LDL and c-HDL), as well as the atherogenic index (CT/c-HDL), were assessed in 307 workers of a health center. The study population was classified into groups, based on age and sex and whether they were health (physicians, registered nurses, clinical assistants) or non-health staff. The lipidic profile of the health staff groups was similar to the profile of non-health staff groups of the same age and sex. The percentage of subjects with CT above 200 mg/dl. was significantly higher (79.6 vs 60.9%) (p < 0.05) among the male health staff versus the male non-health staff and lower among the female health staff versus the female non-health staff (34.5 vs 55.5%) (p < 0.05). The differences in the lipidic profile depending on age and sex were confirmed grouping the population on the basis of such criteria. We highlight that all groups, with the exception of the female health staff, had CT levels above those recommended by the W...
Revista portuguesa de cardiologia : orgão oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology, 1995
To evaluate the antihypertensive efficacy at rest and under exercise, and the modifications induc... more To evaluate the antihypertensive efficacy at rest and under exercise, and the modifications induced on the left ventricular mass in patients treated with two different doses of a diuretic. Fifty hypertensive males, mean age 51 years, received during nine months 50 mg/day of chlortalidone and thirteen 25 mg/day for the next nine months. Baseline tension control and echocardiogram and each three months after starting therapy during the two phases of the study were performed. Thickness of the interventricular septum and posterior left ventricular wall in mm, left ventricular mass index in g/m2 were determined. The baseline septum was 15 +/- 3.3 mm, 14.6 +/- 3.1 mm at 9 months and 14.5 +/- 2.9 mm at 18 months, the posterior wall was 14.1 +/- 3.1 mm at baseline, 13.7 +/- 2.9 mm at 9 months and 13.6 +/- 2.9 mm at 18 months. The left ventricular mass index was 153 +/- 45 g/m2 at baseline, 146 +/- 36 g/m2 at 9 months and 144 +/- 39 g/m2 at 18 months. The antihypertensive efficacy at rest an...
BACKGROUND AND OBJECTIVE: Early alterations in retinal microcirculation are observed in most hype... more BACKGROUND AND OBJECTIVE: Early alterations in retinal microcirculation are observed in most hypertensive patients seen in daily practice and the European guidelines consider it is necessary an objective method to quantify these alterations. We have previously ...
Renal replacement therapies which consist of renal transplantation and dialysis are the only trea... more Renal replacement therapies which consist of renal transplantation and dialysis are the only treatment options for patients with terminal renal failure. These therapies have changed the outcome from being fatal to being a chronic disease. Kidney transplantation involves the use of immunosuppressive agents to prevent rejection. Currently, several immunosuppressive agents have shown efficacy, safety, and different costs. The aim was to evaluate the cost-effectiveness of early conversion from tacrolimus to mammalian target of rapamycin inhibitors sirolimus or everolimus versus continuous treatment with tacrolimus among renal transplantat patients in Colombia. We performed systematic literature review to extract data for clinical effectiveness and safety of tacrolimus replacement schemes for immunosuppressive therapy in renal transplantation in adults. A Markov model in TreeAge was developed, simulating the patient&#39;s natural history with renal transplantation. The perspective of the Colombian Health System was used, including only direct costs. The cost-effectiveness ratio and incremental cost-effectiveness ratio were estimated. Deterministic and probabilistic sensitivity analyses were performed. A 5% discount rate was applied in costs and health results. Results for the replacement of tacrolimus to sirolimus are provided. The cost per year of additional life gained for sirolimus was Col$2,441,171.43; the cost for avoided loss was Col$4,014,152.84. The acceptability curve shows that a strategy with sirolimus is the most cost-effective one. This study suggested that the sirolimus strategy is cost-effective in Colombia for patients with renal transplantation using as threshold less than three times the gross domestic product (GDP) per capita of Colombia per life of years gained.
Background. Elderly patients are the fastest growing population requiring renal replacement thera... more Background. Elderly patients are the fastest growing population requiring renal replacement therapy. It has been stated that renal transplantation may be the best treatment option for these patients. However, it has been observed that older patients have a higher mortality rate than those who are younger. Yet the factors that determine posttransplantation outcomes in this population remain poorly defined. The aims of this study were to evaluate the graft and patient survival in kidney transplant recipients who are older than 60 years of age to identify relevant predictive factors. Methods. In this population-based retrospective cohort study of 201 kidney transplantations performed in elderly patients from January 2002 throughout June 2009, we estimated the 1-,3-,and 5-year patients and graft survival rates. We also evaluated the complications and the predictors of poor outcomes. Survival times were analyzed using the Kaplan-Meier method and survival differences assessed with Mantel-Cox log rank-test. We performed a Cox proportional hazards regression models to evaluate the impact of baseline and treatment characteristics on patient and graft survival. Results. Graft and patient survival rates at 1, 3, and 5 years were 76.4%, 71.3%, and 54.3%, and 78.2%, 73.8%, and 56.4%, respectively. Graft survival rates censored for patient death with a functioning graft were 93.1, 92.1, and 89%. Patient survival rates differed between diabetic and nondiabetic subjects at 1, 3 and 5 years (69.5% versus 83.6%; 59.8% versus 72.3%; 43.6% versus 65.7%; P ϭ .008). On multivariate analysis, the factors associated with patients survival were diabetes mellitus (hazard ratio [HR] 2.058, 95% confidence interval [CI] 1.173-3.611, P ϭ .012) and the 1-month serum creatinine value was Ͼ 1.6 mg/dL (HR 2.108 for each point increase, 95% CI 1.521-2.921, P ϭ .000). Furthermore, there was an insignificant trend forward an association between active or past smoker and lower patient survival (HR 1.689, 95% CI 0.937-3.043, P ϭ .08). The main causes of graft loss were patient death (79.5%). acute rejection (6.8%), and chronic allograft nephropathy (5.5%). Conclusion. Renal transplantation can be performed safely and with acceptable outcomes in elderly patients after appropriate clinical evaluation. The grafts show excellent survival albeit that deaths with a functional graft continue to be an important issue.
This study was intended to assess the efficacy and safety of ezetimibe when taken alone or combin... more This study was intended to assess the efficacy and safety of ezetimibe when taken alone or combined with statins in a specialized care setting and under standard clinical practice conditions. A multicenter, retrospective study in patients with dyslipidemia seen in a specialized outpatient clinic and treated with ezetimibe for at least 12 weeks. Patients were divided into three groups: monotherapy, add-on ezetimibe, and initial coadministration. A total of 217 patients (mean age 59 years; 37% ≥65 years) were enrolled. Of these, 61% were women, 21% had type 2 diabetes and 20% had had a previous cardiovascular event so that the lipid lower drug treatment should satisfy the objectives of secondary prevention. Mean change in the monotherapy group (n = 92; mean 41 weeks) included: decrease of LDLc of 28% (P &amp;amp;amp;amp;amp;amp;lt;.001). In the group where ezetimibe was added on to different ongoing statins (n = 94, mean 73 weeks), mean changes was as follows: LDLc -34%, significant change as compared to monotherapy (P &amp;amp;amp;amp;amp;amp;lt; .001). In the group with initial coadministration of ezetimibe with different statins (n = 31; mean 118 weeks), mean change included: LDLc -53% (P &amp;amp;amp;amp;amp;amp;lt; .001). Overall, 64% of patients reached the thereapeutic objective proposed for the Adult Treatment Panel III (ATPIII) for cLDL. In patients with low risk (LDLc &amp;amp;amp;amp;amp;amp;lt; 160 mg/dL), moderate risk (LDLc &amp;amp;amp;amp;amp;amp;lt; 130 mg/dL) and high-very high risk (LDLc &amp;amp;amp;amp;amp;amp;lt; 100-70 mg/dL), the percentage of patients who reached the therapeutic objective was 81%, 64% and 44%, respectively. Under standard clinical practice conditions, ezetimibe appears to be effective and safe for the control LDLc, thus making it possible to reach the therapeutic objectives proposed by the ATP-III in a high number of patients, especially when associated to statins.
The fovea is a spot located in the center of the macula, and responsible for sharp central vision... more The fovea is a spot located in the center of the macula, and responsible for sharp central vision. In this paper a method to detect the macula location and size is presented, as a first step towards the fovea location. Prior to the macula detection, the optic disk size and position is computed. This is performed through the combination of two stages: firstly, a clustering algorithm is used to select the regions which contain the pixels with the highest gray levels. A correlation filter is applied to these regions to compute the approximate center of the optic disk. Then, in order to extract the optic disk, a deformable model which is used. Then, following the morphological properties of the eye, the macula location and size is determined by means of a new correlation filter. Search with this filter is performed in a reduced area of interest, whose size and position is determined by means, again, of the morphological properties of the eye. The algorithm has proven to be fast and accu...
To validate a computer-based method for measuring the calibre of retinal blood vessels, and use i... more To validate a computer-based method for measuring the calibre of retinal blood vessels, and use it to determine the effects of ageing and arterial hypertension on the calibres of these vessels and on their ratio. Digital eye fundus images covering a 50 degrees field and centred on the optic disc were obtained using a 540 nm filter. The boundaries of blood vessels crossing a series of circles concentric with the optic disc were located by an image analysis program; the calibres of vessels crossing the circles perpendicularly were determined automatically, the average arteriole and average vein calibres were calculated, and the arteriovenous ratio (AVR) was calculated as the ratio of these averages. The within-operator, between-operator and within-eye reliability of this method was investigated using images of 30 or 40 eyes; the effects of ageing on average vessel calibres and AVR using both eyes of each of 120 normotensive volunteers aged 10-69 years (60 males, 60 females); and the effects of arterial hypertension using a group of 54 hypertensive patients aged 50.9 +/- 13.9 years. Within-operator, between-operator and within-eye correlation coefficients for AVR were all better than 0.95, and the corresponding coefficients of variation were all better than 3%. The results of Bland Altman approach show a very good agreement. There were no significant differences between right and left eyes or between the sexes in either the normotensive or the hypertensive group. In the normotensive group, vein calibre was almost constant (111 +/- 6 microm), but arteriole calibre and AVR fell significantly from 96 +/- 6 microm and 0.870 +/- 0.046, respectively, in the second decade of life to 85 +/- 4 microm and 0.761 +/- 0.044 in the seventh decade. Arterial hypertension was not associated with changes in vein calibre, but was associated with decreases in arteriole calibre (from 91 +/- 7 microm among normotensive individuals to 84 +/- 2 microm) and AVR (from 0.816 +/- 0.056 to 0.755 +/- 0.027). Age significantly modulated the AVR-reducing influence of hypertension (P = 0.003). The proposed method of measuring retinal blood vessel calibres is reliable and precise (especially for the AVR). In this study, its results confirmed that increasing age and arterial hypertension are both associated with reductions in retinal arteriole calibre and AVR.
Background Timeliness of care is an important dimension of health care quality. The determining f... more Background Timeliness of care is an important dimension of health care quality. The determining factors of less timely care and their influence on the survival of patients with lung cancer (LC) remain uncertain. Aims To analyse the delays in the diagnosis and treatment of LC in our health area, the factors associated with the timeliness of care and their possible relationship with the survival of these patients. Methods A retrospective study was conducted on all patients with a cytohistologically confirmed diagnosis of LC between 1 June 2005 and 31 May 2008. The time delays for consultation (specialist delay), diagnosis (diagnosis delay), and treatment (treatment delay), were analysed, as well as the factors associated with these delays and the influence of the timeliness of care on survival.
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Papers by A. Reino