Papers by miguel morales gomez
BACKGROUND The Internet has become the most widely-used source for patients seeking information m... more BACKGROUND The Internet has become the most widely-used source for patients seeking information more about their health and many sites geared towards this audience have gained widespread use in recent years. Additionally, many healthcare institutions publish their own patient-education web sites with information regarding common conditions. Little is known about how these resources impact patient health, though, as they have the potential both to inform and to misinform patients regarding their prognosis and possible treatments. In this study we investigated the reliability, readability and quality of information about femoracetabular impingement, a condition which commonly affects young patients. METHODS The terms "hip impingement" and "femoracetabular impingement" were searched in Google® in November 2013 and the first 30 results were analyzed. The LIDA scale was used to assess website accessibility, usability and reliability. The DISCERN scale was used to asse...
The Journal of Arthroplasty, 2017
Background: Preoperative antibiotic prophylaxis remains one of the most important strategies for ... more Background: Preoperative antibiotic prophylaxis remains one of the most important strategies for preventing periprosthetic joint infection (PJI). Current guidelines recommend giving universal antibiotic prophylaxis to all total joint arthroplasty (TJA) patients regardless of their medical conditions or immune status; however, no studies have evaluated the individualizing of antibiotics. The aims of this study were 1) to determine if comorbidities influence the organism profile of PJIs and 2) to investigate if the efficacy of two different perioperative antibiotics (cefazolin or vancomycin) for preventing PJI is affected by patient comorbidities. Methods: Using an institutional database of 1022 PJIs, the influence of different patient comorbidities on the organism profile was evaluated. To investigate the influence of perioperative antibiotics (cefazolin or vancomycin monotherapy) on PJI rate, 8575 primary TJAs were identified, crossmatched for PJI, and analyzed based on the comorbidities of the cohort. The PJI rate of each antibiotic within each comorbidity was compared. Results: While no comorbidities were associated with an increased rate of gram-positive infections or gram-negative infections, metastatic disease (odds ratio [OR] 5.71, p=0.018), congestive heart failure (OR 2.2, p=0.010), chronic pulmonary disease (OR 1.76, p=0.015), and diabetes (OR 1.66, p=0.019) were associated with antibiotic resistant organisms. However, there was no difference in the PJI rate between cefazolin and vancomycin monotherapy when stratifying for diabetes, rheumatoid arthritis, liver disease, and hypothyroidism.
The Journal of Arthroplasty, 2017
Failure of 2-stage exchange arthroplasty for the management of periprosthetic joint infection (PJ... more Failure of 2-stage exchange arthroplasty for the management of periprosthetic joint infection (PJI) poses a major clinical challenge. There is a paucity of information regarding the outcomes of further surgical intervention in these patients. Thus, we aim to report the clinical outcomes of subsequent surgery for a failed prior 2-stage exchange arthroplasty. Our institutional database was used to identify 60 patients (42 knees and 18 hips), with a failed prior 2-stage exchange, who underwent further surgical intervention between 1998 and 2012, and had a minimum 2-year follow-up. A retrospective review was performed to extract relevant clinical information, including mortality, microbiology, and subsequent surgeries. Musculoskeletal Infection Society criteria were used to define PJI, and treatment success was defined using Delphi criteria. Irrigation and debridement (I&D) was performed after a failed 2-stage exchange in 61.7% of patients; 56.8% subsequently failed. Forty patients underwent an intended second 2-stage exchange; 6 cases required a spacer exchange. Reimplantation occurred only in 65% of cases, and 61.6% had infection controlled. The 14 cases that were not reimplanted resulted in 6 retained spacers, 5 amputations, 2 PJI-related mortalities, and 1 arthrodesis. Further surgical intervention after a failed prior 2-stage exchange arthroplasty has poor outcomes. Although I&D has a high failure rate, many patients who are deemed candidates for a second 2-stage exchange either do not undergo reimplantation or fail after reimplantation. The management of PJI clearly remains imperfect, and there is a dire need for further innovations that may improve the care of these patients.
The Journal of bone and joint surgery. American volume, Jan 3, 2016
It is strongly recommended that tissue and synovial fluid culture samples be obtained during reim... more It is strongly recommended that tissue and synovial fluid culture samples be obtained during reimplantation performed as part of a 2-stage exchange arthroplasty. The rate of positive cultures during reimplantation and the influence of positive cultures on subsequent outcomes, to our knowledge, are unknown. This study was designed to determine the rate of positive cultures during reimplantation and to investigate the association between positive cultures at reimplantation and subsequent outcomes. We retrospectively reviewed the data of 259 patients who met the Musculoskeletal Infection Society criteria for periprosthetic joint infection (PJI) and who underwent both stages of 2-stage exchange arthroplasty at our institution from 1999 to 2013. Among these patients were 267 PJIs (186 knees and 81 hips); 33 (12.4%) had ≥1 positive culture result at reimplantation. Treatment failure was assessed according to the Delphi-based consensus definition. Logistic regression analysis was performed...
Revista Iberoamericana De Polimeros, 2009
espanolSe ha estudiado, por calorimetria diferencial de barrido, el comportamiento de cristalizac... more espanolSe ha estudiado, por calorimetria diferencial de barrido, el comportamiento de cristalizacion en condiciones dinamicas del polipropileno isotactico en sus mezclas, entre un 10 y un 40% en peso, con un copolimero de etileno y alcohol vinilico, analizandose la influencia de un copolimero de etileno y acido metacrilico, Ion.Na+, como agente compatibilizante. La temperatura de cristalizacion del iPP se ve sensiblemente aumentada por la presencia del EVOH en las mezclas binarias, efecto que es dependiente de la composicion de la mezcla, y que refleja la existencia de un efecto nucleante sobre la cristalizacion del iPP por la presencia de los cristalitos de EVOH previamente formados en el fundido de polipropileno. La presencia del ionomero en las mezclas ternarias anula dicho efecto nucleante, lo que debe atribuirse a un fenomeno de compatibilizacion, que no parece suficiente como para modificar el comportamiento de cristalizacion del EVOH. EnglishDifferential scanning calorimetry was used to study the dynamic crystallization behaviour of isotactic polypropylene in blends with between 10 - 40% by weight of an ethylene-vinyl alcohol copolymer. The influence of a ethylene-methacrylic acid copolymer, Ion.Na+ as a compatibilizing agent was analysed. The crystallization temperature of iPP slightly increased in the presence of EVOH in the binary blends, and was dependant on the blend composition, reflecting the existenceof a nucleating effect on the crystallization of iPP due to the presence of small crystals of EVOH formed in the polypropylene melt. The presence of the ionomer in the ternary blends eliminates the nucleating effect, which can be attributed to a compatibilization phenomenon, although this does not modify the crystallization behaviour of EVOH.
Arthroplasty Today, 2017
Background: Underweight (UW) patients undergoing total hip arthroplasty have exhibited higher com... more Background: Underweight (UW) patients undergoing total hip arthroplasty have exhibited higher complication rates, including infection and transfusion. No study to our knowledge has evaluated UW total knee arthroplasty (TKA) patients. We, therefore, conducted a study to investigate if these patients are at increased risk for complications, including infection and transfusion. Methods: A case-control study was conducted using a prospectively collected institutional database. Twenty-seven TKA patients were identified as UW (body mass index [BMI] < 18.5 kg/m 2) from 2000-2012 and were matched for age, gender, date of surgery, age-adjusted Charlson comorbidity index, rheumatoid arthritis, and diabetes. These patients were compared to 81 normal weight patients (BMI 18.5-24 kg/m 2). Demographic variables were compared, along with wound complications, surgical site infection (SSI), blistering, deep vein thrombosis, pulmonary embolism, transfusion, revision, flexion contracture, hematoma formation, and patellar clunk. Results: The average BMI was 17.1 kg/m 2 (range 12.8-18.4) for UW and 23.0 kg/m 2 (range 19.0-25.0) for normal weight patients (P < .001). UW TKA patients were more likely to develop SSIs (3/27, 11.1% vs 0/81, 0.0%, P ¼ .01) and were more likely to require transfusions (odds ratio ¼ 3.4, confidence interval 1.3-9.1; P ¼ .02). Conclusions: Our study demonstrates that UW TKA patients have a higher likelihood of developing SSI and requiring blood transfusions. The specific reasons are unclear, but we conjecture that it may be related to decreased wound healing capabilities and low preoperative hemoglobin. Investigation of local tissue coverage and hematologic status may be beneficial in this patient population to prevent SSI. Based on the results of this study, a prospective evaluation of these factors should be undertaken.
Cultura Del Cuidado Enfermeria, May 20, 2010
y las incidencias conceptuales en torno a las didácticas, comprendidas aquí en un sentido restric... more y las incidencias conceptuales en torno a las didácticas, comprendidas aquí en un sentido restrictivo-el de las didácticas de las disciplinas-y las del tipo de relaciones que suscita. Varias y distintas miradas surgen en el planteamiento de estas relaciones que podrían conducir a atribuir, según la perspectiva adoptada, sentidos diferentes a la acción didáctica. Saber desde dónde se habla, en cuál contexto de enseñanza-aprendizaje y en función de cuales fines, cuando se trata de didáctica, podría eventualmente contribuir a una cierta clarificación del concepto y de sus diferentes sentidos. Después de recordar la importancia referencial de los fines en toda acción educativa y todo tratamiento didáctico, la atención se centrará, en un segundo momento, sobre las relaciones entre didácticas y disciplinas, para destacar la relación, ciertamente necesaria, pero sin embargo relativa, de las didácticas con los saberes escolares disciplinares, subrayando su carácter interdisciplinario. Esta constatación requiere una clarificación del concepto de disciplinariedad y, en consecuencia, una distinción entre disciplina científica y disciplina escolar.
Policemen's job is considered to be a highly stressful profession, given the fact that profession... more Policemen's job is considered to be a highly stressful profession, given the fact that professionals on this field are exposed to highly violent, harmful and challenging situations. Under highly stressful conditions there are both physical as well as psychological indicators that affect directly the policemen's performance as well as their personal and family life. The purpose of this research is to know the mental and physical health situation of the policemen working at the Criminal Research School (ESINC) and its association with demographic, hierarchy policeman grade, degree, area of specialty, and perceptions regarding imparted orders. A descriptive co-relational and transversal study was executed. The participants were selected by a stratified probabilistic sampling method with proportional affixation. The results show that those who consider that the orders received are abruptly given, suffer pain somewhere in their bodies, feel more tired and experience sadness. Those who consider that their job is excessively loaded manifested that the physical pain carries on difficulty when performing their daily duties and tasks (including those that pertain to personal matters).
Diversitas, 2012
Estado de salud de una muestra de policías y su relación con variables policiales
Cirugía Española (English Edition), 2013
Cirugía Española (English Edition), 2014
Journal of Hepato-Biliary-Pancreatic Sciences, 2011
Rifampicin has been used for the treatment of patients with jaundice and pruritus. This study eva... more Rifampicin has been used for the treatment of patients with jaundice and pruritus. This study evaluated the effect of rifampicin on the expression of different detoxification systems and bile acid transporters during in-vivo and in-vitro experimental models of cholestasis. Rifampicin was administered to glycochenodeoxycholic acid (GCDCA)-treated human hepatocytes and bile duct-obstructed rats. Different parameters related to cell death, and the expression of phase I and II drug metabolizing enzymes (DME) and bile acid transporters were determined. The induction of hepatocellular injury induced by cholestasis was associated with a reduction in cytochrome P4503A4 (CYP3A4), CYP7A1, and UDP-glucuronosyltransferase 2B4 (UGT2B4) expression, as well as an increase in import (Na(+)-taurocholate co-transporting polypeptide, NTCP) system expression. The beneficial properties of rifampicin were associated with an increase in DME and export bile acid systems (multidrug resistance-associated protein 4, MRP4, and bile acid export pump to bile duct, BSEP) expression, as well as a reduction in NTCP expression. The beneficial effect of rifampicin in cholestasis is associated with an increase in DME expression involved in toxic, bile acid and cholesterol metabolism, as well as a reduction in the bile acid importing system in hepatocytes.
The Journal of Arthroplasty, 2015
PROTEOMICS, 2008
The liver is one organ clearly influenced by nitric oxide (NO), and acute and chronic exposure to... more The liver is one organ clearly influenced by nitric oxide (NO), and acute and chronic exposure to this substance has been associated with distinct patterns of liver disease. Disruption or deregulation of S-nitrosothiol (SNO) signalling leads to impairment of cellular function and disease, and this study was aimed to identify potential targets for protein S-nitrosation during alteration of SNO homeostasis in human hepatocytes. Cells were treated with S-nitroso-L-cysteine (CSNO), an effective physiological nitrosothiol for delivering NO bioactivity to cells. Treatment with CSNO augmented the levels of S-nitrosoproteins detected both by chemiluminescence and the biotin switch method. CSNO treatment also increased S-nitrosoglutathione reductase (GSNOR) activity that returned SNO content to basal levels. This increased enzymatic activity was related to augmented levels of ADH-5 mRNA, the gene encoding for GSNOR in humans. In addition, the treatment with the SNO also increased cell death. Twenty S-nitrosoproteins were identified in CSNO-treated hepatocytes, including mitochondrial aldehyde dehydrogenase, protein disulphide isomerase, Hsp60, GRP75 and Raf kinase inhibitor protein. The identification in the Snitrosatable proteome of proteins involved in metabolism, maintenance of cellular homeostasis and signalling points to the relevance of protein S-nitrosation to the physiology and pathophysiology of human hepatocytes.
The Journal of Nervous and Mental Disease, 2007
The purpose of the study was to do an exploratory factor analysis and to examine the criterion-re... more The purpose of the study was to do an exploratory factor analysis and to examine the criterion-related and discriminant validity of the Lifetime Severity Index for Cocaine (LSI-C), Spanish version. A sample of 171 outpatients from 10 drug centers in Spain participated in the study. We conducted the factor analysis with orthogonal rotation and examined correlations between the LSI-C total score and criterion variables as well as the score obtained by a quality of life measure. The factor analysis revealed 2 principal factors that explain 65.8% of the variance. Lower LSI-C scores were associated with taking medication, receiving social help, using cocaine fewer than 30 times during the previous 6 months, and with better scores on quality of life measures. Higher LSI-C scores were associated with unstable housing, overdose, hospitalization, cocaine consumption more than 100 times during the previous 6 months, and more years of drug consumption. The LSI-C Spanish version shows acceptable criterion-related and discriminant validity.
Journal of Feline Medicine and Surgery, 2013
An 8-year-old intact male Persian cat was presented for investigation of chronic haematuria. The ... more An 8-year-old intact male Persian cat was presented for investigation of chronic haematuria. The cat had episodes of haematuria on several occasions that were non-responsive to antimicrobial therapy. Abdominal ultrasound examination revealed dilation of the renal pelvis and ureters of both kidneys. The urinary bladder wall was thickened, a mass of heterogeneous echogenicity filled the lumen of the bladder, and two parallel thin hyperechoic lines were identified within the lumen, which suggested a urethral catheter. Differential diagnoses for the urinary bladder mass included cystitis and neoplasia. The mass was surgically removed from the urinary bladder, and a urethral catheter was found embedded in the mass. Histopathological findings were consistent with cystitis glandularis of a typical type. Periodic bladder ultrasonographic studies were performed; at the time of writing, over 2 years later, recurrence had not been detected.
The Journal of Emergency Medicine, 1997
This prospective randomized study compared length of stay, hospital charges, and outcome in emerg... more This prospective randomized study compared length of stay, hospital charges, and outcome in emergency department (ED) management and routine hospital admission for ruling out myocardial ischemia in low-risk patients with chest pain. One hundred patients over a 19-month period met study inclusion criteria: age ~30 years, chest pain or related symptoms unexplained by trauma or chest radiograph abnormalities, low (7%) probability of infarction by the Goldman algorithm, and absence of electrocardiogram (EKG) ischemic changes. Patients were randomly assigned to either routine hospital admission (n = 50) or the ED rapid-rule-out protocol (n = SO). All decisions on admitted patients were made by their attending physician. Rapid-ruleout patients were given ASA and oxygen and were admitted to the ED chest pain observation unit. Patients with no ischemit EKG changes and negative cardiac enzymes after 9 h were analyzed by exercise treadmill testing or dobutamine stress echocardiography. Final disposition was based on these results. Following patient randomization, hospital stays were shorter (11.9 vs. 22.8 h, p = 0.0001) and hospital charges were less ($893 vs. $1,349, p = 0.0001) in the rapid-rule-out versus the routine care group. One patient in each group was ruled in for myocardial infarction. No diagnoses were missed in either group at the end of the 30day follow-up period. The authors of this study concluded that. in low-risk patients, the ED can rule out myocardial ischemia more efficiently and with fewer hospital charges that it can rule out inpatient admissions. [Robert Grman, MD] Editor's Comment: This study supports the idea that the emergency department is a proper environment for managing low-risk patients with chest pain. The algorithm and inclusion criteria, however, need to be studied further with larger patient numbers.
The Journal of Arthroplasty, 2004
Limitation of motion after knee arthroplasty can be the result of a multiplicity of factors. Amon... more Limitation of motion after knee arthroplasty can be the result of a multiplicity of factors. Among these are malpositioning of the components, especially in the sagittal plane; oversizing at the patellofemoral or tibiofemoral joint spaces; retaining posterior osteophytes; and persisting with a tight posterior cruciate ligament. Postoperatively, problems with physical therapy likewise can cause limitation of both extension and flexion. Specific patient factors also may affect the range of motion after surgery. Although most patients achieve a postoperative flexion that is highly correlated to that which was present preoperatively, factors such as pain, obesity, and deformities of adjacent joints may limit such motion.
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Papers by miguel morales gomez