|
1: Bruce
N, Perez-Padilla R, Albalak R. Indoor air pollution in developing countries:
a major environmental and public health challenge. Bull World Health Organ.
2000;78(9):1078-92. Review.
2: Carrillo-Rodriguez
JG, Sansores RH, Castrejon A, Perez-Padilla R, Ramirez-Venegas A, Selman
M. [Hypersensitivity pneumonitis in Mexico City]. Salud Publica Mex. 2000
May-Jun;42(3):201-7. Spanish.
3:
Perez Padilla JR, Vazquez Garcia JC. [Estimation of gasometric values
at different altitudes above sea level in Mexico]. Rev Invest Clin. 2000
Mar-Apr;52(2):148-55. Spanish.
4:
Perez-Padilla R, Vazquez-Garcia JC, Meza-Vargas S. [The surgical risk
in sleep apnea: the implications for tonsillectomies]. Gac Med Mex. 1999
Sep-Oct;135(5):501-6. Review. Spanish.
5:
Perez-Padilla JR. [Ketotifen (Zaditen and K-Asthmal): a drug with sales
disproportionate to its demonstrated effectiveness]. Gac Med Mex. 1999
Mar-Apr;135(2):165-70. Review. Spanish.
6:
Perez-Padilla JR, Regalado-Pineda J, Moran-Mendoza AO. [The domestic inhalation
of the smoke from firewood and of other biological materials. A risk for
the development of respiratory diseases]. Gac Med Mex. 1999 Jan-Feb;135(1):19-29.
Spanish.
7:
Vazquez-Garcia JC, Arellano-Vega SL, Regalado-Pineda J, Perez-Padilla
JR. [Normal ventilatory response to hypoxia and hypercapnia at an altitude
of 2240 meters]. Rev Invest Clin. 1998 Jul-Aug;50(4):323-9. Spanish.
8:
Volkow P, Perez-Padilla R, del-Rio C, Mohar A. The role of commercial
plasmapheresis banks on the AIDS epidemic in Mexico. Rev Invest Clin.
1998 May-Jun;50(3):221-6.
9:
Ramirez-Venegas A, Sansores RH, Perez-Padilla R, Carrillo G, Selman M.
Utility of a provocation test for diagnosis of chronic pigeon Breeder's
disease. Am J Respir Crit Care Med. 1998 Sep;158(3):862-9.
10:
Selman M, Perez-Padilla R, Pardo A. Problems encountered in high-level
research in developing countries. Chest. 1998 Aug;114(2):610-3. Review.
No abstract available.
11:
Perez Padilla R. [More on the medicine-industry relationship]. Rev Invest
Clin. 1997 Jul-Aug;49(4):343. Spanish. No abstract available.
12:
Romieu I, Meneses F, Ramirez M, Ruiz S, Perez Padilla R, Sienra JJ, Gerber
M, Grievink L, Dekker R, Walda I, Brunekreef B. Antioxidant supplementation
and respiratory functions among workers exposed to high levels of ozone.
Am J Respir Crit Care Med. 1998 Jul;158(1):226-32.
13: Chi-Lem G, Perez-Padilla R. Gas exchange at rest during simulated
altitude in patients with chronic lung disease. Arch Med Res. 1998 Spring;29(1):57-62.
14:
Perez-Padilla R, Regalado J, Vedal S, Pare P, Chapela R, Sansores R, Selman
M. Exposure to biomass smoke and chronic airway disease in Mexican women.
A case-control study. Am J Respir Crit Care Med. 1996 Sep;154(3 Pt 1):701-6.
15:
Perez-Padilla R, Gaxiola M, Salas J, Mejia M, Ramos C, Selman M. Bronchiolitis
in chronic pigeon breeder's disease. Morphologic evidence of a spectrum
of small airway lesions in hypersensitivity pneumonitis induced by avian
antigens. Chest. 1996 Aug;110(2):371-7.
16:
Sansores RH, Ramirez-Venegas A, Perez-Padilla R, Montano M, Ramos C, Becerril
C, Gaxiola M, Pare P, Selman M. Correlation between pulmonary fibrosis
and the lung pressure-volume curve. Lung. 1996;174(5):315-23.
17:
Perez-Padilla R, Gaxiola M, Salas J, Sansores R, Chapela R, Carrillo G,
Selman M. [Capability of clinical and laboratory findings to predict the
grade of fibrosis and the diagnosis in diffuse interstitial lung diseases].
Rev Invest Clin. 1995 Mar-Apr;47(2):95-101. Spanish.
18:
Perez-Padilla R. [The uncertain future of Mexican medical journals]. Rev
Invest Clin. 1995 Mar-Apr;47(2):165-7. Spanish. No abstract available.
19:
Perez Padilla R, Volkow Fernandez P. [Mexican physicians succeed with
a live plant tissue graft in animals: this opens new therapeutic possibilities].
Gac Med Mex. 1994 May-Jun;130(3):176-7. Spanish. No abstract available.
20:
Selman-Lama M, Perez-Padilla R. Airflow obstruction and airway lesions
in hypersensitivity pneumonitis. Clin Chest Med. 1993 Dec;14(4):699-714.
Review.
21:
Perez-Padilla R, Salas J, Chapela R, Sanchez M, Carrillo G, Perez R, Sansores
R, Gaxiola M, Selman M. Mortality in Mexican patients with chronic pigeon
breeder's lung compared with those with usual interstitial pneumonia.
Am Rev Respir Dis. 1993 Jul;148(1):49-53.
22:
Perez-Padilla JR, Slawinski E, Difrancesco LM, Feige RR, Remmers JE, Whitelaw
WA. Characteristics of the snoring noise in patients with and without
occlusive sleep apnea. Am Rev Respir Dis. 1993 Mar;147(3):635-44.
23:
Perez Martinez SO, Perez-Padilla JR. [Gasometric values reported in healthy
subjects from the Mexican population: review and analysis]. Rev Invest
Clin. 1992 Jul-Sep;44(3):353-62. Spanish.
24:
Perez-Padilla R, Salas J, Carrillo G, Selman M, Chapela R. Prevalence
of high hematocrits in patients with interstitial lung disease in Mexico
City. Chest. 1992 Jun;101(6):1691-3.
25:
Sansores R, Perez-Padilla R, Pare PD, Selman M. Exponential analysis of
the lung pressure-volume curve in patients with chronic pigeon-breeder's
lung. Chest. 1992 May;101(5):1352-6.
26:
Sandoval J, Cicero R, Seoane M, Perez-Padilla R, Quesada A, Lupi-Herrera
E. Behavior of the pulmonary circulation at rest and during exercise in
miliary tuberculosis. Chest. 1991 Jan;99(1):152-4.
27:
Viniegra L, Jimenez JL, Perez-Padilla JR. [The challenge of evaluating
clinical competence]. Rev Invest Clin. 1991 Jan-Mar;43(1):87-98. Spanish.
28:
Perez-Padilla JR, Ponce de Leon-Rosales S. [Ethical attitudes related
to problems of managing patients with acquired immunodeficiency syndrome].
Salud Publica Mex. 1990 Jan-Feb;32(1):3-14. Spanish.
29:
Hatridge J, Haji A, Perez-Padilla JR, Remmers JE. Rapid shallow breathing
caused by pulmonary vascular congestion in cats. J Appl Physiol. 1989
Dec;67(6):2257-64.
30:
Perez-Padilla JR, Viniegra Velazquez L. [Method for calculating the distribution
of randomly expected scores in a false-true-do not know-type of test].
Rev Invest Clin. 1989 Oct-Dec;41(4):375-9. Spanish.
31:
Perez-Padilla R, Cervantes D, Chapela R, Selman M. Rating of breathlessness
at rest during acute asthma: correlation with spirometry and usefulness
of breath-holding time. Rev Invest Clin. 1989 Jul-Sep;41(3):209-13.
32:
Zamora Mucino A, Gomez Jaume A, Gorodezky M, Perez Padilla R, Amigo MC,
Barrios R. [Cardiovascular abnormalities in Ehlers-Danlos syndrome. Report
of a case]. Arch Inst Cardiol Mex. 1989 May-Jun;59(3):301-7. Spanish.
33:
Perez-Padilla JR, Molina Tellez E, Barragan Garcia R. [Obstructive sleep
apnea syndrome associated with nasal, velo-pharyngeal and tracheal stenosis.
Surgical management of a case including uvulo-palato-pharyngoplasty].
Rev Invest Clin. 1988 Apr-Jun;40(2):171-5. Spanish. No abstract available.
34:
Martinez W, Sandoval J, Perez-Padilla R, Maxwell R, Seoane M, Lupi-Herrera
E. PaO2 increases with coughing in patients with chronic lung disease.
Lung. 1988;166(5):287-91.
35:
Perez-Padilla JR, West P, Kryger M. Snoring in normal young adults: prevalence
in sleep stages and associated changes in oxygen saturation, heart rate,
and breathing pattern. Sleep. 1987 Jun;10(3):249-53.
36:
Perez-Padilla R, Conway W, Roth T, Anthonisen N, George C, Kryger M. Hypercapnia
and sleep O2 desaturation in chronic obstructive pulmonary disease. Sleep.
1987 Jun;10(3):216-23.
37:
Light RB, Perez-Padilla R, Kryger MH. Perfluorochemical artificial blood
as a volume expander in hypoxemic respiratory failure in dogs. Chest.
1987 Mar;91(3):444-9.
38:
Perez-Padilla JR, Bracamonte-Peraza R, Manrique G, Ruiz-Primo ME. [Accuracy
of an the ear oximeter Biox-III and its sensitivity to carboxyhemoglobin
in Mexico City]. Arch Inst Cardiol Mex. 1986 Jul-Aug;56(4):303-7. Spanish.
39:
Perez Padilla JR, Lupi Herrera E. [Respiratory problems during sleep].
Arch Inst Cardiol Mex. 1986 Jan-Feb;56(1):1-3. Spanish. No abstract available.
40:
Perez-Padilla R, West P, Lertzman M, Kryger MH. Breathing during sleep
in patients with interstitial lung disease. Am Rev Respir Dis. 1985 Aug;132(2):224-9.
41:
Perez Padilla JR. [Clinical implications of snoring]. Rev Invest Clin.
1984 Apr-Jun;36(2):155-65. Spanish. No abstract available.
42:
Perez-Padilla R, Sifuentes-Osornio J, Sada-Diaz E, Guerrero FJ, Nunez-Rasilla
V, Diaz-Jouanen E. [Extrapulmonary manifestations and rapidly fatal course
in 3 patients with desquamative pneumonitis]. Rev Invest Clin. 1984 Jan-Mar;36(1):39-43.
Spanish. No abstract available.
43:
Brownell LG, Perez-Padilla R, West P, Kryger MH. The role of protriptyline
in obstructive sleep apnea. Bull Eur Physiopathol Respir. 1983 Nov-Dec;19(6):621-4.
44:
Perez-Padilla R, West P, Kryger MH. Sighs during sleep in adult humans.
Sleep. 1983;6(3):234-43.
45:
Perez Padilla JR. [Rehydration therapy without insulin in severe hyperglycemia.
Report of one case]. Rev Invest Clin. 1981 Jan-Mar;33(1):49-51. Spanish.
No abstract available.
46:
de Lascurain RE, Perez Padilla JR. [Fever of unknown origin. A report
of 55 cases seen at the National Institute of Nutrition from 1971 to 1977].
Rev Invest Clin. 1980 Apr-Jun;32(2):243-54. Spanish. No abstract available.
Citas
en MEDLINE:
1: Perez-Padilla
JR, Regalado-Pineda J, Vazquez-Garcia JC.
Reproducibilidad de espirometrías en trabajadores mexicanos y valores
de referencia internacionales. Salud Publica Mex. 2001 Mar-Apr;43(2):113-21.
Spanish.
PMID: 11381840 [PubMed - in process]
2: Perez-Padilla
R, Perez-Guzman C, Baez-Saldana R, Torres-Cruz A.
Cooking with biomass stoves and tuberculosis: a case control study.
Int J Tuberc Lung Dis. 2001 May;5(5):441-7.
PMID: 11336275 [PubMed - in process]
3: Perez-Padilla
R.
[Tuberculosis in Mexico, an old public health debt].
Gac Med Mex. 2001 Jan-Feb;137(1):93-4. Spanish. No abstract available.
PMID: 11244837 [PubMed - indexed for MEDLINE]
4: Bruce N, Perez-Padilla
R, Albalak R.
Indoor air pollution in developing countries: a major environmental and
public health challenge.
Bull World Health Organ. 2000;78(9):1078-92. Review.
PMID: 11019457 [PubMed - indexed for MEDLINE]
5: Carrillo-Rodriguez
JG, Sansores RH, Castrejon A, Perez-Padilla R, Ramirez-Venegas A,
Selman M.
[Hypersensitivity pneumonitis in Mexico City].
Salud Publica Mex. 2000 May-Jun;42(3):201-7. Spanish.
PMID: 10929501 [PubMed - indexed for MEDLINE]
6: Perez Padilla
JR, Vazquez Garcia JC.
[Estimation of gasometric values at different altitudes above sea level
in Mexico].
Rev Invest Clin. 2000 Mar-Apr;52(2):148-55. Spanish.
PMID: 10846438 [PubMed - indexed for MEDLINE]
7: Perez-Padilla
R, Vazquez-Garcia JC, Meza-Vargas S.
[The surgical risk in sleep apnea: the implications for tonsillectomies].
Gac Med Mex. 1999 Sep-Oct;135(5):501-6. Review. Spanish.
PMID: 10596490 [PubMed - indexed for MEDLINE]
8: Perez-Padilla
JR.
[Ketotifen (Zaditen and K-Asthmal): a drug with sales disproportionate
to its demonstrated
effectiveness].
Gac Med Mex. 1999 Mar-Apr;135(2):165-70. Review. Spanish.
PMID: 10327750 [PubMed - indexed for MEDLINE]
9: Perez-Padilla
JR, Regalado-Pineda J, Moran-Mendoza AO.
[The domestic inhalation of the smoke from firewood and of other biological
materials. A risk for
the development of respiratory diseases].
Gac Med Mex. 1999 Jan-Feb;135(1):19-29. Spanish.
PMID: 10204309 [PubMed - indexed for MEDLINE]
10: Vazquez-Garcia
JC, Arellano-Vega SL, Regalado-Pineda J, Perez-Padilla JR.
[Normal ventilatory response to hypoxia and hypercapnia at an altitude
of 2240 meters].
Rev Invest Clin. 1998 Jul-Aug;50(4):323-9. Spanish.
PMID: 9830321 [PubMed - indexed for MEDLINE]
11: Volkow P, Perez-Padilla
R, del-Rio C, Mohar A.
The role of commercial plasmapheresis banks on the AIDS epidemic in Mexico.
Rev Invest Clin. 1998 May-Jun;50(3):221-6.
PMID: 9763887 [PubMed - indexed for MEDLINE]
12: Ramirez-Venegas
A, Sansores RH, Perez-Padilla R, Carrillo G, Selman M.
Utility of a provocation test for diagnosis of chronic pigeon Breeder's
disease.
Am J Respir Crit Care Med. 1998 Sep;158(3):862-9.
PMID: 9731018 [PubMed - indexed for MEDLINE]
13: Selman M, Perez-Padilla
R, Pardo A.
Problems encountered in high-level research in developing countries.
Chest. 1998 Aug;114(2):610-3. Review. No abstract available.
PMID: 9726752 [PubMed - indexed for MEDLINE]
14: Perez Padilla
R.
[More on the medicine-industry relationship].
Rev Invest Clin. 1997 Jul-Aug;49(4):343. Spanish. No abstract available.
PMID: 9708002 [PubMed - indexed for MEDLINE]
15: Romieu I, Meneses
F, Ramirez M, Ruiz S, Perez Padilla R, Sienra JJ, Gerber M, Grievink L,
Dekker R, Walda I, Brunekreef B.
Antioxidant supplementation and respiratory functions among workers exposed
to high levels of ozone.
Am J Respir Crit Care Med. 1998 Jul;158(1):226-32.
PMID: 9655734 [PubMed - indexed for MEDLINE]
16: Chi-Lem G, Perez-Padilla
R.
Gas exchange at rest during simulated altitude in patients with chronic
lung disease.
Arch Med Res. 1998 Spring;29(1):57-62.
PMID: 9556924 [PubMed - indexed for MEDLINE]
17: Perez-Padilla
R, Regalado J, Vedal S, Pare P, Chapela R, Sansores R, Selman M.
Exposure to biomass smoke and chronic airway disease in Mexican women.
A case-control
study.
Am J Respir Crit Care Med. 1996 Sep;154(3 Pt 1):701-6.
PMID: 8810608 [PubMed - indexed for MEDLINE]
18: Perez-Padilla
R, Gaxiola M, Salas J, Mejia M, Ramos C, Selman M.
Bronchiolitis in chronic pigeon breeder's disease. Morphologic evidence
of a spectrum of small
airway lesions in hypersensitivity pneumonitis induced by avian antigens.
Chest. 1996 Aug;110(2):371-7.
PMID: 8697836 [PubMed - indexed for MEDLINE]
19: Sansores RH, Ramirez-Venegas A, Perez-Padilla R, Montano M, Ramos
C, Becerril C,
Gaxiola M, Pare P, Selman M.
Correlation between pulmonary fibrosis and the lung pressure-volume curve.
Lung. 1996;174(5):315-23.
PMID: 8843057 [PubMed - indexed for MEDLINE]
20: Perez-Padilla
R, Gaxiola M, Salas J, Sansores R, Chapela R, Carrillo G, Selman M.
[Capability of clinical and laboratory findings to predict the grade of
fibrosis and the diagnosis in
diffuse interstitial lung diseases].
Rev Invest Clin. 1995 Mar-Apr;47(2):95-101. Spanish.
PMID: 7610289 [PubMed - indexed for MEDLINE]
21: Perez-Padilla
R.
[The uncertain future of Mexican medical journals].
Rev Invest Clin. 1995 Mar-Apr;47(2):165-7. Spanish. No abstract available.
PMID: 7610287 [PubMed - indexed for MEDLINE]
22: Perez Padilla
R, Volkow Fernandez P.
[Mexican physicians succeed with a live plant tissue graft in animals:
this opens new therapeutic
possibilities].
Gac Med Mex. 1994 May-Jun;130(3):176-7. Spanish. No abstract available.
PMID: 7657084 [PubMed - indexed for MEDLINE]
23: Selman-Lama
M, Perez-Padilla R.
Airflow obstruction and airway lesions in hypersensitivity pneumonitis.
Clin Chest Med. 1993 Dec;14(4):699-714. Review.
PMID: 8313674 [PubMed - indexed for MEDLINE]
24: Perez-Padilla
R, Salas J, Chapela R, Sanchez M, Carrillo G, Perez R, Sansores R, Gaxiola
M,
Selman M.
Mortality in Mexican patients with chronic pigeon breeder's lung compared
with those with usual
interstitial pneumonia.
Am Rev Respir Dis. 1993 Jul;148(1):49-53.
PMID: 8317813 [PubMed - indexed for MEDLINE]
25: Perez-Padilla
JR, Slawinski E, Difrancesco LM, Feige RR, Remmers JE, Whitelaw WA.
Characteristics of the snoring noise in patients with and without occlusive
sleep apnea.
Am Rev Respir Dis. 1993 Mar;147(3):635-44.
PMID: 8442599 [PubMed - indexed for MEDLINE]
26: Perez Martinez
SO, Perez-Padilla JR.
[Gasometric values reported in healthy subjects from the Mexican population:
review and
analysis].
Rev Invest Clin. 1992 Jul-Sep;44(3):353-62. Spanish.
PMID: 1488580 [PubMed - indexed for MEDLINE]
27: Perez-Padilla
R, Salas J, Carrillo G, Selman M, Chapela R.
Prevalence of high hematocrits in patients with interstitial lung disease
in Mexico City.
Chest. 1992 Jun;101(6):1691-3.
PMID: 1600793 [PubMed - indexed for MEDLINE]
28: Sansores R,
Perez-Padilla R, Pare PD, Selman M.
Exponential analysis of the lung pressure-volume curve in patients with
chronic pigeon-breeder's
lung.
Chest. 1992 May;101(5):1352-6.
PMID: 1582296 [PubMed - indexed for MEDLINE]
29: Sandoval J, Cicero
R, Seoane M, Perez-Padilla R, Quesada A, Lupi-Herrera E.
Behavior of the pulmonary circulation at rest and during exercise in miliary
tuberculosis.
Chest. 1991 Jan;99(1):152-4.
PMID: 1984947 [PubMed - indexed for MEDLINE]
30: Viniegra L,
Jimenez JL, Perez-Padilla JR.
[The challenge of evaluating clinical competence].
Rev Invest Clin. 1991 Jan-Mar;43(1):87-98. Spanish.
PMID: 1866504 [PubMed - indexed for MEDLINE]
31: Perez-Padilla
JR, Ponce de Leon-Rosales S.
[Ethical attitudes related to problems of managing patients with acquired
immunodeficiency
syndrome].
Salud Publica Mex. 1990 Jan-Feb;32(1):3-14. Spanish.
PMID: 2330511 [PubMed - indexed for MEDLINE]
32: Hatridge J,
Haji A, Perez-Padilla JR, Remmers JE.
Rapid shallow breathing caused by pulmonary vascular congestion in cats.
J Appl Physiol. 1989 Dec;67(6):2257-64.
PMID: 2606831 [PubMed - indexed for MEDLINE]
33: Perez-Padilla
JR, Viniegra Velazquez L.
[Method for calculating the distribution of randomly expected scores in
a false-true-do not
know-type of test].
Rev Invest Clin. 1989 Oct-Dec;41(4):375-9. Spanish.
PMID: 2631171 [PubMed - indexed for MEDLINE]
34: Perez-Padilla
R, Cervantes D, Chapela R, Selman M.
Rating of breathlessness at rest during acute asthma: correlation with
spirometry and usefulness of
breath-holding time.
Rev Invest Clin. 1989 Jul-Sep;41(3):209-13.
PMID: 2813994 [PubMed - indexed for MEDLINE]
35: Zamora Mucino
A, Gomez Jaume A, Gorodezky M, Perez Padilla R, Amigo MC, Barrios R.
[Cardiovascular abnormalities in Ehlers-Danlos syndrome. Report of a case].
Arch Inst Cardiol Mex. 1989 May-Jun;59(3):301-7. Spanish.
PMID: 2782994 [PubMed - indexed for MEDLINE]
36: Perez-Padilla
JR, Molina Tellez E, Barragan Garcia R.
[Obstructive sleep apnea syndrome associated with nasal, velo-pharyngeal
and tracheal stenosis.
Surgical management of a case including uvulo-palato-pharyngoplasty].
Rev Invest Clin. 1988 Apr-Jun;40(2):171-5. Spanish. No abstract available.
PMID: 3175371 [PubMed - indexed for MEDLINE]
37: Martinez W,
Sandoval J, Perez-Padilla R, Maxwell R, Seoane M, Lupi-Herrera E.
PaO2 increases with coughing in patients with chronic lung disease.
Lung. 1988;166(5):287-91.
PMID: 3146675 [PubMed - indexed for MEDLINE]
38: Perez-Padilla
JR, West P, Kryger M.
Snoring in normal young adults: prevalence in sleep stages and associated
changes in oxygen
saturation, heart rate, and breathing pattern.
Sleep. 1987 Jun;10(3):249-53.
PMID: 3629087 [PubMed - indexed for MEDLINE]
39: Perez-Padilla R, Conway W, Roth T, Anthonisen N, George C, Kryger
M.
Hypercapnia and sleep O2 desaturation in chronic obstructive pulmonary
disease.
Sleep. 1987 Jun;10(3):216-23.
PMID: 3629083 [PubMed - indexed for MEDLINE]
40: Light RB, Perez-Padilla
R, Kryger MH.
Perfluorochemical artificial blood as a volume expander in hypoxemic respiratory
failure in dogs.
Chest. 1987 Mar;91(3):444-9.
PMID: 3816321 [PubMed - indexed for MEDLINE]
41: Perez-Padilla
JR, Bracamonte-Peraza R, Manrique G, Ruiz-Primo ME.
[Accuracy of an the ear oximeter Biox-III and its sensitivity to carboxyhemoglobin
in Mexico
City].
Arch Inst Cardiol Mex. 1986 Jul-Aug;56(4):303-7. Spanish.
PMID: 2945522 [PubMed - indexed for MEDLINE]
42: Perez Padilla
JR, Lupi Herrera E.
[Respiratory problems during sleep].
Arch Inst Cardiol Mex. 1986 Jan-Feb;56(1):1-3. Spanish. No abstract available.
PMID: 2943239 [PubMed - indexed for MEDLINE]
43: Perez-Padilla
R, West P, Lertzman M, Kryger MH.
Breathing during sleep in patients with interstitial lung disease.
Am Rev Respir Dis. 1985 Aug;132(2):224-9.
PMID: 2411177 [PubMed - indexed for MEDLINE]
44: Perez Padilla
JR.
[Clinical implications of snoring].
Rev Invest Clin. 1984 Apr-Jun;36(2):155-65. Spanish. No abstract available.
PMID: 6484335 [PubMed - indexed for MEDLINE]
45: Perez-Padilla
R, Sifuentes-Osornio J, Sada-Diaz E, Guerrero FJ, Nunez-Rasilla V,
Diaz-Jouanen E.
[Extrapulmonary manifestations and rapidly fatal course in 3 patients
with desquamative
pneumonitis].
Rev Invest Clin. 1984 Jan-Mar;36(1):39-43. Spanish. No abstract available.
PMID: 6718828 [PubMed - indexed for MEDLINE]
46: Brownell LG,
Perez-Padilla R, West P, Kryger MH.
The role of protriptyline in obstructive sleep apnea.
Bull Eur Physiopathol Respir. 1983 Nov-Dec;19(6):621-4.
PMID: 6360257 [PubMed - indexed for MEDLINE]
47: Perez-Padilla
R, West P, Kryger MH.
Sighs during sleep in adult humans.
Sleep. 1983;6(3):234-43.
PMID: 6622880 [PubMed - indexed for MEDLINE]
48: Perez Padilla
JR.
[Rehydration therapy without insulin in severe hyperglycemia. Report of
one case (author's
transl)].
Rev Invest Clin. 1981 Jan-Mar;33(1):49-51. Spanish. No abstract available.
PMID: 7268230 [PubMed - indexed for MEDLINE]
49: de Lascurain
RE, Perez Padilla JR.
[Fever of unknown origin. A report of 55 cases seen at the National Institute
of Nutrition from
1971 to 1977].
Rev Invest Clin. 1980 Apr-Jun;32(2):243-54. Spanish. No abstract available.
PMID: 7423082 [PubMed - indexed for MEDLINE]
Resúmenes
(Abstracts). de algunos artículos ya mencionados.
Salud Publica Mex
2001 Mar-Apr;43(2):113-21
Perez-Padilla JR, Regalado-Pineda J, Vazquez-Garcia JC.
Instituto Nacional de Enfermedades Respiratorias, Departamento de Fisiologia
Respiratoria,
Calzada de Tlalpan 4502, 14080 Mexico, D.F., Mexico. perezpad@servidor.unam.mx
OBJECTIVE: To describe
spirometric function and adjustment to foreign prediction equations in
Mexican workers claiming work related disability. MATERIAL AND METHODS:
We
reviewed 5771 spirometries done at the Mexican National Institute of Respiratory
Diseases
performed with equipment and methods proposed by the American Thoracic
Society. With the
spirometries we generated multiple regression equations separated for
men and women based on
age and height, compared to other in common use reported by Knudson and
Hankinson in North
America and by Quanjer in europeans. RESULTS: 80% of the tests were reproducible
for FVC
and FEV1 according to ATS, whereas 10% were reproducible for neither.
Mean FVC in men
was 12% above values reported by Quanjer, 22% above Knudson, 3% above
Hankinson and
6% above Rodriguez-Reynaga, whereas similar values for women were 18%,
10%, 0% and 1%.
Excluding obese and those who had less than 2 acceptable maneuvers, the
numbers increase by
1-2%. FEV1 was also above predicted. CONCLUSIONS: Most workers requesting
disability
are able to generate a reproducible spirometry. However for the same gender,
age and height,
workers had a FEV1 and a FVC above normal values reported by Knudson and
Quanjer and
are more similar to those reported by Hankinson in Mexican-Americans.
While a set of
appropriate reference values are obtained, regression equations obtained
from the studied group
will generate less error in the evaluation of disability in mexican workers.
The English version of
this paper is available at: http://www.insp.mx/salud/index.html.
PMID: 11381840 [PubMed
- in process]
Am J Respir Crit
Care Med 1998 Sep;158(3):862-9
Utility of a provocation test for diagnosis of chronic pigeon Breeder's
disease.
Ramirez-Venegas A, Sansores RH, Perez-Padilla R, Carrillo G, Selman M.
Instituto Nacional de Enfermedades Respiratorias, Mexico DF, Mexico.
Chronic hypersensitivity
pneumonitis (CHP) can be difficult to differentiate from other interstitial
lung diseases (ILD). To determine the diagnostic usefulness of a provocation
test (PT), 17
patients with CHP induced by avian antigens, 17 with other ILD, and five
healthy control subjects
were challenged with pigeon serum. After PT, an increase in body temperature
(BT) and a
decrease in FVC, PaO2 and SaO2% were observed in all patients with CHP
and in three with
ILD. No reaction was noticed in healthy subjects. ROC curves showed that
for FVC the best cut
point was a drop of 16% displaying sensitivity (S): 76%, specificity (SP):
81%, positive
predictive value (PPV): 81%, and negative predictive value (NPV): 83%.
For a drop of 3 mm
Hg in PaO2 or 3% SaO2, S was 88% for both, SP was 82 and 86%, PPV was
81 and 82%,
and NPV was 82 and 86%, respectively. An increase of BT > 0.5(o) C
showed S, 100%; SP,
82%; PPV, 100%; NPV, 86%. A univariate regression analysis confirmed that
changes in BT
and FVC are predicting values of CHP: RR, 82.5 (CI, 10.43 to 651.76) and
1.21 (CI, 1.06 to
1.36). There were no challenge test complications. These findings suggest
that PT is a useful tool
for diagnosis of CHP.
PMID: 9731018 [PubMed
- indexed for MEDLINE]
Int J Tuberc Lung
Dis 2001 May;5(5):441-7
Cooking with biomass stoves and tuberculosis: a case control study.
Perez-Padilla R, Perez-Guzman C, Baez-Saldana R, Torres-Cruz A.
National Institute
of Respiratory Diseases, Tlalpan, Mexico City, Mexico.
perezpad@servidor.unam.mx
OBJECTIVE: To search
for an association between tuberculosis and use of biomass stoves
found recently in a cross sectional study. DESIGN: In a case-control study
based in a chest
referral hospital, the cases were 288 patients with active smear-positive
or culture-positive
tuberculosis, and the controls were 545 patients with ear nose and throat
ailments with no
evidence of chest disease studied at the same time as the cases. Exposure
to present or previous
biomass smoke by history of cooking with traditional wood stoves was assessed
by positive or
negative response. RESULTS: Exposure to biomass smoke was significantly
higher in cases than
in controls. Crude odds ratios for tuberculosis and biomass smoke exposure
were 5.2 (95%CI
3.1-8.9) for current exposure, 3.4 (95%CI 2.4-5.0) for past or present
exposure and 1.8
(95%CI 1.1-3.0) for past exposure. The association was observed only for
patients living in
Metropolitan Mexico City and urban or suburban areas in the center of
Mexico providing most
cases and controls. For rural areas, the power of the study was low and
the origin of the patients
heterogeneous. Odds ratio for Mexico City Metropolitan area and the center
of Mexico was 2.4
(95%CI 1.04-5.6), adjusted for age, sex, level of education, crowding,
smoking,
socio-economic level, zone of residence and state of birth. In the same
model smoking had an
OR of 1.5 (95%CI 1.0-2.3) for tuberculosis. CONCLUSION: Our results support
a causal role
of current domestic biomass smoke exposure in tuberculosis.
PMID: 11336275 [PubMed - in process]
Gac Med Mex 2001
Jan-Feb;137(1):93-4
[Tuberculosis in Mexico, an old public health debt]. [Article in Spanish]
Perez-Padilla R.
Instituto Nacional
de Enfermedades Respiratorias, Tlalpan 4502 Mexico DF, 14080.
perezpad@servidor.unam.mx
PMID: 11244837 [PubMed
- indexed for MEDLINE]
Salud Publica Mex
2000 May-Jun;42(3):201-7
[Hypersensitivity pneumonitis in Mexico City]. [Article in Spanish]
Carrillo-Rodriguez JG, Sansores RH, Castrejon A, Perez-Padilla R, Ramirez-Venegas
A, Selman M.
Clinica de Enfermedades
Intersticiales del Pulmon, Instituto Nacional de Enfermedades
Respiratorias (INER), Mexico. josecr@data.net.mx
OBJECTIVE: To investigate
the association between the urban area of origin of patients and the
prevalence of hypersensitivity pneumonitis (HP), induced by avian antigens.
MATERIAL AND
METHODS: A case-control study was conducted in 1999 at the National Institute
of
Respiratory Diseases (NIRD). Cases were 109 consecutive HP patients and
controls were 184
patients: 39 with idiopathic pulmonary fibrosis (IPF), 63 with pulmonary
tuberculosis (PTB), and
82 with asthma. Mexico City and surrounding counties (SC) were divided
into 5 geographical
areas: 1) Downtown; 2) North-East (NE); 3) South-East (SE); 4) North-West
(NW) and 5)
South-West (SW). Statistical analysis consisted of calculation of disease
prevalence by urban
area; associations were assessed with odds ratios and 95% confidence intervals.
Multivariate
analysis with multiple logistic regression was performed to adjust for
age, gender and
socioeconomic level. RESULTS: Eighty HP cases were located in the NE southernmost
and SE
northernmost areas of Mexico City (48 and 32, respectively) (OR = 3.86;
95% CI 2.17-6.96).
Thirty-six controls with asthma came from the SW area, (where NIRD is
located) (p < 0.05),
and four from SC. Controls with PTB and IPF were scattered throughout
the study area.
CONCLUSIONS: The NE southernmost and SE northernmost areas were associated
with HP.
The cause of HP may not be geographical; a garbage dump used to be located
in this area,
suggesting that exposure to organic particles might contribute to the
development of HP in
susceptible individuals.
PMID: 10929501 [PubMed
- indexed for MEDLINE]
Gac Med Mex 1999
Sep-Oct;135(5):501-6
[The surgical risk in sleep apnea: the implications for tonsillectomies].
[Article in Spanish]
Perez-Padilla R, Vazquez-Garcia JC, Meza-Vargas S.
Departamento de Fisiologia Respiratoria, Laboratorio de Sueno, Instituto
Nacional de
Enfermedades Respiratorias, Tlalpan, Mexico DF. perezpad@servidor.unam.mx
Hypertrophy of tonsils
or adenoids is the commonest cause of obstructive sleep apnea (OSA) in
children. Adenotonsillectomy (AT) is frequently curative in children with
OSA but riskier than the
same procedure without OSA. It is crucial to identify OSA among the patients
programmed for
AT because they require a detailed evaluation, frequently including total
or limited
polysomnogram. Patients with OSA need a continuous surveillance before,
during, and after
surgery, ideally in a referral hospital.
PMID: 10596490 [PubMed - indexed for MEDLINE]
Am. J. Respir. Crit.
Care Med., Vol 154, No. 3, 09 1996, 701-706.
Exposure to biomass smoke and chronic airway disease in Mexican women.
A case-control study
R Perez-Padilla, J Regalado, S Vedal, P Pare, R Chapela, R Sansores and
M Selman
National Institute of Pulmonary Diseases, Mexico City, DF, Mexico.
A case-control study
was performed in women older than 40 yr of age to evaluate the risk of
cooking
with traditional wood stoves for chronic bronchitis and chronic airway
obstruction (CAO). The subjects were recruited from patients attending
a referral chest hospital in Mexico City. We selected 127 patients with
chronic bronchitis or CAO, of which 63 had chronic bronchitis alone, 23
had CAO alone (FEV1 less than 75% of predicted), and 41 had both chronic
bronchitis and CAO (cases). Four control groups were selected: 83
patients with pulmonary tuberculosis, 100 patients with interstitial lung
diseases, 97 patients with ear, nose and throat ailments, and 95 healthy
visitors to the hospital (controls). Exposure to wood smoke, assessed
as any or none, and as hour-years (years of exposure multiplied by
average hours of exposure per day) was significantly higher in cases than
in controls. Crude odds ratios for wood smoke exposure were 3.9
(95% CI, 2.0 to 7.6) for chronic bronchitis only, 9.7 (95% CI, 3.7 to
27) for CAO plus chronic bronchitis, and 1.8 (95% CI, 0.7 to 4.7) for
CAO only.
Differences in exposure to wood smoke persisted after adjusting by stratification
and logistic regression for age, income, education, smoking,
place of residence, and place of birth. Risk of chronic bronchitis alone
and chronic bronchitis with CAO increased linearly with hour-years of
cooking with a wood stove; odds ratios for exposure to more than 200 hour-years
compared with nonexposed were 15.0 (95% CI, 5.6 to 40) for
chronic bronchitis only and 75 (95% CI, 18 to 306) for chronic bronchitis
with CAO. The findings support a causal role of domestic wood smoke
exposure in chronic bronchitis and chronic airflow obstruction.
This article has
been cited by other articles:
Albalak, R, Frisancho,
A R, Keeler, G J (1999). Domestic biomass fuel combustion and chronic
bronchitis in two rural Bolivian villages.
Thorax 54: 1004-1008 [Abstract] [Full Text]
Smith, K. R. (2000). Inaugural Article: National burden of disease in
India from indoor air pollution. Proc. Natl. Acad. Sci. U. S. A. 97:
13286-13293 [Abstract] [Full Text]
PAUWELS, R. A., BUIST, A. S., CALVERLEY, P. M. A., JENKINS, C. R., HURD,
S. S. (2001). Global Strategy for the Diagnosis,
Management, and Prevention of Chronic Obstructive Pulmonary Disease .
NHLBI/WHO Global Initiative for Chronic Obstructive Lung
Disease (GOLD) Workshop Summary. Am J Respir Crit Care Med 163: 1256-1276
[Full Text]
Rev Invest Clin 2000
Mar-Apr;52(2):148-55
[Estimation of gasometric values at different altitudes above sea level
in Mexico].
[Article in Spanish]
Perez Padilla JR, Vazquez Garcia JC.
Instituto Nacional de Enfermedades Respiratorias. perezpad@servidor.unam.mx
We calculated reference
values for arterial blood gases at different altitudes in Mexico assuming
that sea level PaCO2 is 40 Torr, and in Mexico City (2.24 km. above the
sea level) is 31.13
Torr, average of reported reference values. With the previous two points,
it is possible to
calculate a linear regression: PaCO2 = 40-3.96(altitude in km.). The equation
is very similar to
that calculated from reports in alveolar gas in North-Americans (Fitzgerald
< 5 km): PACO2 =
39.3-3.11(altitude in km), and from subjects acclimatized to acute altitude
exposure (< 5 km):
PACO2 = 38.3-2.5 (altitude in km). It is also similar to a alinear equation
that can be calculated
assuming that hyperventilation in permanent habitants of moderate altitudes
is inversely
proportional to inspired molar concentration of O2: PaCO2 = PIO2/3.74.
On the other hand, the
equation is very different than that obtained from Andean natives (Hurtado):
PaCO2 =
40.4-1.35(altitude in km). The proposed linear equation for Mexico gives
very similar results (<
2 Torr difference) than a complex curvilinear equation by Morris et al.
appropriate only up to 2.3
km. Evidence from acute exposure to altitude (acclimatized) and in North-Americans
(alveolar
gas) supports a reasonably accurate linear relationship up to 4 km. and
also that the increase in
ventilation in response to moderate altitudes in adult permanent residents
is inversely proportional
to molar concentration of O2. PAO2 was calculated with alveolar gas equation
and resting the
P(A-a)O2 we obtained PaO2. In conclusion, according to reference values
in Mexico City,
PaCO2 decreases about 4 Torr per km of altitude above the sea level. The
decrease is similar to
that reported in North-Americans and in acute exposure to altitude (acclimatized),
but much less
than that reported in native Peruvians. Ventilation is inversely proportional
to the molar
concentration of O2 at least up to an altitude where SaO2 is at or above
90%.
PMID: 10846438 [PubMed
- indexed for MEDLINE]
Bull World Health
Organ 2000;78(9):1078-92
Indoor air pollution in developing countries: a major environmental and
public health challenge.
Bruce N, Perez-Padilla R, Albalak R.
Department of Public Health, University of Liverpool, England. ngb@liv.ac.uk
Around 50% of people,
almost all in developing countries, rely on coal and biomass in the form
of wood, dung and crop residues for domestic energy. These materials are
typically burnt in
simple stoves with very incomplete combustion. Consequently, women and
young children are
exposed to high levels of indoor air pollution every day. There is consistent
evidence that indoor
air pollution increases the risk of chronic obstructive pulmonary disease
and of acute respiratory
infections in childhood, the most important cause of death among children
under 5 years of age in
developing countries. Evidence also exists of associations with low birth
weight, increased infant
and perinatal mortality, pulmonary tuberculosis, nasopharyngeal and laryngeal
cancer, cataract,
and, specifically in respect of the use of coal, with lung cancer. Conflicting
evidence exists with
regard to asthma. All studies are observational and very few have measured
exposure directly,
while a substantial proportion have not dealt with confounding. As a result,
risk estimates are
poorly quantified and may be biased. Exposure to indoor air pollution
may be responsible for
nearly 2 million excess deaths in developing countries and for some 4%
of the global burden of
disease. Indoor air pollution is a major global public health threat requiring
greatly increased
efforts in the areas of research and policy-making. Research on its health
effects should be
strengthened, particularly in relation to tuberculosis and acute lower
respiratory infections. A
more systematic approach to the development and evaluation of interventions
is desirable, with
clearer recognition of the interrelationships between poverty and dependence
on polluting fuels.
PMID: 11019457 [PubMed - indexed for MEDLINE]
Gac Med Mex 1999
Mar-Apr;135(2):165-70
[Ketotifen (Zaditen and K-Asthmal): a drug with sales disproportionate
to its demonstrated effectiveness]. [Article in Spanish]
Perez-Padilla JR.
Departamento de
Fisiologia, Instituto Nacional de Enfermedades Respiratorias, Mexico,
D.F.
perezpad@servidor.unam.mx
Ketotifen is a sedative
antihistamine promoted heavily for asthma treatment. Controlled trials
are
inconsistent: several did not find ketotifen better than placebo or cromoglycate.
We do not have
published controlled trials against inhaled steroids, the comparison most
important to evaluate the
efficacy of ketotifen. Ketotifen is poorly effective against exercise-induced
asthma, and unable to
reduce bronchial hyperactivity. The sedation and delay in therapeutic
effect is also bothersome.
Because of the uncertainties of its effect, ketotifen is not a first line
drug against asthma, according
to several international guidelines. Despite this information, ketotifen
represented 17% of all
antiasthmatic drug sales in Mexico in 1996, clearly exaggerated for the
efficacy demonstrated.
Ketotifen for asthma can be substituted with advantage by inhaled cromoglycate
or
corticosteroids. As a sedative antihistamine it is very expensive. The
authorized publicity
concerning ketotifen should be reevaluated with the current information
available.
PMID: 10327750 [PubMed - indexed for MEDLINE]
Gac Med Mex 1999
Jan-Feb;135(1):19-29
[The domestic inhalation of the smoke from firewood and of other
biological materials. A risk for the development of respiratory diseases].
[Article in Spanish]
Perez-Padilla JR, Regalado-Pineda J, Moran-Mendoza AO.
Instituto Nacional
de Enfermedades Respiratorias, Tlalpan, Mexico.
perezpad@servidor.unam.mx
A high proportion
of the world population, especially in developing countries, is exposed
to
indoor pollutants produced by inefficient biomass stoves. The levels of
pollutants, including toxins
and carcinogens in the kitchen are usually very high. This potential pathogenic
exposure has been
scarcely studied. The exposure to biomass smoke has been associated to
chronic bronchitis and
chronic airflow obstruction in adults and to acute respiratory infections
in children. At the
National Institute of Pulmonary Diseases in Mexico, we have observed the
entire spectrum of
diseases associated with tobacco in people who never smoked and who were
exposed to wood
smoke. Women exposed to wood smoke had a five-fold risk of chronic bronchitis
and chronic
airflow obstruction, as compared to the non-exposed, according to a recent
case-control study
done at our Institute. The indoor levels of suspended particles smaller
than 10 microns were
frequently above 1,000 micrograms/m3 in a rural community in the state
of Mexico. This
information supports a causal role for biomass smoke for the genesis of
several respiratory
diseases, representing a potentially public health problem.
PMID: 10204309 [PubMed - indexed for MEDLINE]
Rev Invest Clin 1998
Jul-Aug;50(4):323-9
[Normal ventilatory response to hypoxia and hypercapnia at an altitude
of 2240 meters].
[Article in Spanish] Vazquez-Garcia JC, Arellano-Vega SL, Regalado-Pineda
J, Perez-Padilla JR.
Departamento de
Fisiologia Respiratoria, Instituto Nacional de Enfermedades Respiratorias,
INER, Mexico DF.
OBJECTIVE: To evaluate
the ventilatory response to hypoxia and hypercapnia in healthy
residents of Mexico City at 2240 m above sea level. METHODS: 15 healthy
subjects, 10
women and 5 men, were studied (mean age 38; range 26-76). All completed
one or two tests of
ventilatory response to hypoxia and hypercapnia as described by Rebuck-Campbell
and Read,
respectively. The results were analyzed by linear regression using the
minute ventilation as the
dependent variable and SaO2 (hypoxia) or PCO2 (hypercapnia) as the independent
variables.
RESULTS: Seven subjects had very low or no response to hypoxia. The mean
hypoxia slope
was 0.7 +/- 0.6 L/min/% (+/- SD) and the hypercapnia slope was 3.0 +/-
1.4 L/min/mmHg. The
intercepts were 176 +/- 278 for SaO2 and 3.0 +/- 7 for PCO2. CONCLUSIONS:
A low
respiratory response to hypoxia was found in Mexico City Healthy residents.
The response to
hypercapnia was similar in slope to other studies but had an intercept
shifted to lower values. The
Mexico City residents showed a behavior typical of patients with chronic
hypoxemia or of
dwellers at high altitudes.
PMID: 9830321 [PubMed - indexed for MEDLINE]
Am J Respir Crit Care Med 1998 Jul;158(1):226-32
Antioxidant supplementation and respiratory functions among workers
exposed to high levels of ozone.
Romieu I, Meneses F, Ramirez M, Ruiz S, Perez Padilla R, Sienra JJ, Gerber
M,
Grievink L, Dekker R, Walda I, Brunekreef B.
Pan American Health
Organization; Instituto Nacional de Salud Publica, Cuernavaca, Mor;
Instituto de Investigacion en Matematica Aplicada y Sistemas, Universidad
Autonoma de
Mexico, Mexico DF. iar9@cdc.gov
Ozone exposure has
been related to adverse respiratory effects, in particular to lung function
decrements. Antioxidant vitamins are free-radical scavengers and could
have a protective effect
against photo-oxidant exposure. To evaluate whether acute effects of ozone
on lung functions
could be attenuated by antioxidant vitamin supplementation, we conducted
a randomized trial
using a double-blind crossover design. Street workers (n = 47) of Mexico
City were randomly
assigned to take daily a supplement (75 mg vitamin E, 650 mg vitamin C,
15 mg beta carotene)
or a placebo and were followed from March to August 1996. Pulmonary function
tests were
done twice a week at the end of the workday. During the follow-up, the
mean 1-h maximum
ozone level was 123 ppb (SD = 40). During the first phase, ozone levels
were inversely
associated with FVC (beta = -1.60 ml/ppb), FEV1 (beta = -2.11 ml/ppb),
and FEF25-75 (beta
= -4.92 ml/ppb) (p < 0.05) in the placebo group but not in the supplement
group. The difference
between the two groups was significant for FVC, FEV1, and FEF25-75 (p
< 0.01). During the
second phase, similar results were observed, but the lung function decrements
in the placebo
group were smaller, suggesting that the supplementation may have had a
residual protective effect
on the lung. These results need to be confirmed in larger supplementation
studies.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 9655734 [PubMed - indexed for MEDLINE]
Rev Invest Clin 1998 May-Jun;50(3):221-6
The role of commercial plasmapheresis banks on the AIDS epidemic in Mexico.
Volkow P, Perez-Padilla R, del-Rio C, Mohar A.
Instituto Nacional de Cancerologia, Department of Infectious Diseases,
Mexico D.F.
OBJECTIVE: To characterize
the circumstances underlying the epidemic of AIDS associated
with blood transfusion in Mexico and to explore the possible mechanisms
for its dissemination.
METHODS: A retrospective analysis comparing the total number of AIDS cases
and
transfusion-associated AIDS cases and the male:female ratio reported in
Mexico and the U.S.
from 1981 to 1996 was done. We analyzed the relationship between the location
of
plasmapheresis banks and the geographic distribution of transfusion-associated
AIDS cases and
AIDS cases among paid donors in order to assess the possible role of plasmapheresis
banks in
its dissemination. RESULTS: The proportion of transfusion-associated AIDS
in the total number
of cases was significantly higher in Mexico than in the U.S. from 1987
through 1996 (p < .0001).
A rapid drop in the male:female ratio of AIDS was observed in Mexico but
not in the U.S.
coinciding with a growing number of transfusion associated cases; transfusion
has been the main
risk factor for AIDS in women in our country. In 1986, seven States and
Mexico City had
plasmapheresis banks: they reported 90% of the cases associated to paid
donation and 75% of
those associated to transfusion, despite the fact that commercial blood
banks without
plasmapheresis facilities existed in 23 of the other 24 States. CONCLUSION:
There was a
difference on the frequency of transfusion associated AIDS between Mexico
and the U.S. which
reached epidemic proportions in Mexico. We believe that plasmapheresis
banks played a major
role in the dissemination of the infection in Mexico as paid donors provided
a third of the blood
used in Mexico in 1986. These findings highlight important implications
for the prevention of
AIDS in developing countries where commercial plasmapheresis practices
are still in operation.
PMID: 9763887 [PubMed - indexed for MEDLINE]
Arch Med Res 1998
Spring;29(1):57-62
Gas exchange at rest during simulated altitude in patients with chronic
lung disease.
Chi-Lem G, Perez-Padilla R.
Department of Respiratory
Physiology, National Institute of Respiratory Diseases, Mexico, D.F.,
Mexico.
BACKGROUND: To characterize
the gasometric and oximetric response to simulated altitudes
of 3,100 m and sea level of patients with Chronic Obstructive Pulmonary
Disease (COPD) and
Interstitial Lung Disease (ILD) studied at 2,240 m above sea level. METHODS:
Consecutive
stable patients with COPD and ILD were studied at the National Institute
of Respiratory
Diseases, a referral center for pulmonary diseases in Mexico City, and
a healthy control group.
The patients breathed room air (FIO2 = 0.21), for at least 15 min, then,
a hypoxic mixture (FIO2
= 0.18, simulating 3,100 m), and finally, a hyperoxic mixture (FIO2 =
0.28, simulating sea level).
Arterial blood gases and oxygen saturation were measured by a pulse oximeter
at the end of each
stage. RESULTS: Twelve patients with COPD, 13 patients with ILD and 11
healthy controls
were studied. The PaCO2 and pH were constant in the three study stages
in both groups of
patients and controls. A slope of PaO2 vs. altitude of 9 Torr per Km was
found for each of the
study's patients, either by simple linear regression or multiple regression,
which is identical to that
previously obtained at sea level with COPD patients (Gong et al.). Oxygen
desaturation per Km
of altitude change was alinear, higher for the hypoxic than for the hyperoxic
challenge and more
severe for the most hypoxic patients. CONCLUSIONS: Exposure tests to simulated
altitudes are
safe, and orient the physician concerning the patient's condition at altitudes
different from the
place where the measurement is done. Alveolar ventilation remains constant
despite hypoxia or
hyperoxia during the challenges. A computer model of the lung reproduces
many of the findings in
the challenges of this study.
PMID: 9556924 [PubMed - indexed for MEDLINE]
Am J Respir Crit
Care Med 1996 Sep;154(3 Pt 1):701-6
Exposure to biomass smoke and chronic airway disease in Mexican women.
A case-control study.
Perez-Padilla R, Regalado J, Vedal S, Pare P, Chapela R, Sansores R, Selman
M.
National Institute
of Pulmonary Diseases, Mexico City, DF, Mexico.
A case-control study
was performed in women older than 40 yr of age to evaluate the risk of
cooking with traditional wood stoves for chronic bronchitis and chronic
airway obstruction
(CAO). The subjects were recruited from patients attending a referral
chest hospital in Mexico
City. We selected 127 patients with chronic bronchitis or CAO, of which
63 had chronic
bronchitis alone, 23 had CAO alone (FEV1 less than 75% of predicted),
and 41 had both
chronic bronchitis and CAO (cases). Four control groups were selected:
83 patients with
pulmonary tuberculosis, 100 patients with interstitial lung diseases,
97 patients with ear, nose and
throat ailments, and 95 healthy visitors to the hospital (controls). Exposure
to wood smoke,
assessed as any or none, and as hour-years (years of exposure multiplied
by average hours of
exposure per day) was significantly higher in cases than in controls.
Crude odds ratios for wood
smoke exposure were 3.9 (95% CI, 2.0 to 7.6) for chronic bronchitis only,
9.7 (95% CI, 3.7 to
27) for CAO plus chronic bronchitis, and 1.8 (95% CI, 0.7 to 4.7) for
CAO only. Differences in
exposure to wood smoke persisted after adjusting by stratification and
logistic regression for age,
income, education, smoking, place of residence, and place of birth. Risk
of chronic bronchitis
alone and chronic bronchitis with CAO increased linearly with hour-years
of cooking with a
wood stove; odds ratios for exposure to more than 200 hour-years compared
with nonexposed
were 15.0 (95% CI, 5.6 to 40) for chronic bronchitis only and 75 (95%
CI, 18 to 306) for
chronic bronchitis with CAO. The findings support a causal role of domestic
wood smoke
exposure in chronic bronchitis and chronic airflow obstruction.
PMID: 8810608 [PubMed - indexed for MEDLINE]
Chest 1996 Aug;110(2):371-7
Bronchiolitis in chronic pigeon breeder's disease. Morphologic evidence
of
a spectrum of small airway lesions in hypersensitivity pneumonitis induced
by avian antigens.
Perez-Padilla R, Gaxiola M, Salas J, Mejia M, Ramos C, Selman M.
Instituto Nacional
de Enfermedades Respiratorias, Mexico, DF, Mexico.
We analyzed 36 open
lung biopsy specimens from patients with chronic pigeon breeder's disease
(PBD) to assess bronchiolar involvement and its relationship to the parenchymal
pathologic
abnormalities. Likewise, 21 biopsy specimens obtained from patients with
usual interstitial
pneumonia (UIP) were also examined. The bronchiolar abnormalities were
scored by the method
of Wright et al using a panel of photographs. In addition, the severity
of lung fibrosis was
evaluated in all samples and expressed as percentage in multiples of ten.
A variable degree of
epithelial cell metaplasia, bronchiolar inflammation and fibrosis, smooth
muscle hypertrophy,
extrinsic small airways narrowing, and intraluminal macrophages was observed
in both diseases.
Occasionally, hyperplasia of lymphoid follicles was also present. Bronchiolar
changes were
proportional in type and severity to the parenchymal damage. Spearman's
nonparametric
correlation between fibrosis in parenchyma and fibrosis in membranous
bronchiole for the
complete group (including patients with UIP and with PBD) showed a moderate
but significant
association (R = 0.51; p < 0.01). A significant association was also
demonstrated when the score
for bronchiolar fibrosis and inflammation was evaluated in relation to
lung fibrosis divided in high
degree (> 50%) and low degree (< 50%), respectively. In the case
of patients with PBD, the
correlation between bronchiolar and parenchymatous fibrosis was of 0.33
(p < 0.05). In general,
bronchiolar fibrosis was less severe and inflammation more severe in PBD
lungs compared with
patients with UIP. Fibrosis in membranous bronchioles correlated with
increased mortality in the
complete group of patients, but the impact on mortality disappeared after
correcting for overall
fibrosis in the biopsy sample. Our findings demonstrate that a spectrum
of bronchiolar lesions is
usually observed in chronic PBD lungs, although the predominant pattern
is similar to that found in
the surrounding parenchyma, suggesting that the damage occurs in parallel.
PMID: 8697836 [PubMed - indexed for MEDLINE]
Arch Inst Cardiol
Mex 1989 May-Jun;59(3):301-7
[Cardiovascular abnormalities in Ehlers-Danlos syndrome. Report of a case].
[Article in Spanish]
Zamora Mucino A, Gomez Jaume A, Gorodezky M, Perez Padilla R, Amigo MC,
Barrios R.
Instituto Nacional
de Cardiologia Ignacio Chavez, Mexico. D.F.
This is the case
of a 34-year-old woman with Ehlers-Danlos syndrome whose cardiopulmonary
manifestations are the following: Prolapse of mitral and tricuspid valves.
Aneurysmal dilatation of
main arteries without aortic or pulmonary insufficiency. Disturbances
in pulmonary function tests
and pulmonary arterial hypertension. The diagnosis was verified by skin
biopsy and an electron
microscopic study. Due to the clinical and histopathological characteristics,
we have considered
this case to be a non-specified type of the 10 varieties described up
to now, and have decided to
report it also because of the interesting findings in the hemodynamic
and pulmonary function tests.
PMID: 2782994 [PubMed - indexed for MEDLINE]
Lung 1988;166(5):287-91
PaO2 increases with coughing in patients with chronic lung disease.
Martinez W, Sandoval J, Perez-Padilla R, Maxwell R, Seoane M, Lupi-Herrera
E.
Cardiopulmonary Service, Instituto Nacional de Cardiologia Ignacio Chavez,
Mexico City,
Mexico.
We considered if
the cyanosis frequently observed during a cough attack in patients with
chronic
lung disease was due to worsening hypoxemia. To investigate the effects
of cough on PaO2, we
measured arterial blood gases before and after a voluntary coughing period
of 45 sec, in 11
patients with Interstitial Lung Disease (ILD) and 14 patients with Chronic
Obstructive Lung
Disease (COPD). All patients significantly increased (p less than 0.05)
their PaO2 (COPD: from
49 +/- 2 to 60 +/- 2 mmHg; ILD from 44 +/- 2 to 51 +/- 3 mmHg, mean +/-
SD) and
decreased their PaCO2. We conclude that stable patients with COPD and
ILD increase their
PaO2 with coughing most likely due to hyperventilation. The cyanosis observed
could be due to
peripheral circulatory effects of coughing.
PMID: 3146675 [PubMed - indexed for MEDLINE]
Sleep 1987 Jun;10(3):249-53
Snoring in normal young adults: prevalence in sleep stages and associated
changes in oxygen saturation, heart rate, and breathing pattern.
Perez-Padilla JR,
West P, Kryger M.
Six men and three
women, asymptomatic light snorers ranging in age from 25-34 years, were
studied during sleep to determine the prevalence of snoring in the different
sleep stages, the
associated changes in oxygen saturation (SaO2), heart rate (HR), and breathing
frequency (f),
and the associated breathing arrhythmias. Snoring was defined as a 1-minute
epoch with more
than 80% of the breaths associated with snores. Most of the snoring epochs
as well as the
apneas and hypopneas occurred during stage 2, mainly because it is the
most prolonged sleep
stage. The prevalence of snoring, however, normalized for differences
in length of sleep stages,
was highest in stages 3 and 4 but low in REM, whereas the converse was
true for apneas and
hypopneas. Snoring caused no change in the mean SaO2, mean HR, or f, as
compared with
nonsnoring periods in the same sleep stage. Continuous snoring in normal
subjects can occur
without significant O2 desaturation or breathing arrhythmia. Continuous
snoring and breathing
arrhythmia tended to occur together in a given subject but were unrelated
in time, suggesting a
different pathogenesis.
PMID: 3629087 [PubMed - indexed for MEDLINE]
Sleep 1987 Jun;10(3):216-23
Hypercapnia and sleep O2 desaturation in chronic obstructive pulmonary
disease.
Perez-Padilla R,
Conway W, Roth T, Anthonisen N, George C, Kryger M.
There is a wide
clinical spectrum in chronic obstructive pulmonary disease (COPD). The
extremes of this spectrum, the "pink puffer" (PP) and "blue
bloater" (BB) stereotypes differ in
their degree of sleep hypoxemia and pulmonary hypertension. Most patients
cannot be
characterized as either PP or BB. The data amassed in the recent nocturnal
oxygen therapy trial
provide an opportunity to see to what extent differences in sleep oxygenation
and hemodynamics
in a large hypoxemic COPD population are related to awake hypoxemia and
hypercapnia. From
a large hypoxemic COPD population sleep SaO2 was examined in those with
(PaCO2 greater
than 44 mm Hg) and without (PaCO2 less than or equal to 44 mm Hg) hypercapnia.
Hypercapnic patients (mean PaCO2 49.8 mm Hg) had the same PaO2 and degree
of airflow
obstruction as normocapnic patients (PaCO2 37.4 mm Hg) but had far greater
sleep hypoxemia
(measured by mean sleep SaO2, low sleep SaO2, and awake-low sleep SaO2,
p less than
0.05). In addition, arterial blood gases of the large sleep O2 desaturaters
were compared with
those of the small desaturaters; PaO2 was similar in both groups, whereas
PaCO2 was different
(p less than 0.01). Two common subsets of hypoxemic patients were also
compared; one was
hypercapnic and overweight, the other normocapnic and hyperinflated. We
found that patients in
the hypercapnic group had far worse sleep hypoxemia, although they had
better lung function.
We conclude that hypercapnia is a marker for sleep O2 desaturation in
hypoxemic COPD.
PMID: 3629083 [PubMed
- indexed for MEDLINE]
Chest 1987 Mar;91(3):444-9
Perfluorochemical artificial blood as a volume expander in hypoxemic respiratory
failure in dogs.
Light RB, Perez-Padilla R, Kryger MH.
The perfluorochemical
O2-transport fluid, Fluosol-DA 20 percent (PFC), is being clinically
evaluated as a volume expander in patients who are unable to receive blood
products. Since
patients treated with Fluosol-DA may be at risk of developing adult respiratory
distress
syndrome (ARDS) as a complication of the original disorder for which they
were transfused, we
examined central hemodynamics and gas exchange in anesthetized O2-ventilated
dogs with
oleic-acid induced pulmonary edema before and after transfusion with 400
ml of either PFC (n =
5) or whole blood (n = 5). Transfusion produced similar increases in cardiac
output, pulmonary
and systemic vascular pressures and intrapulmonary shunt in the two groups.
Arterial O2 tension,
however, fell from 209 +/- 117 to 172 +/- 81 mmHg in the blood transfused
group but increased
from 219 +/- 145 to 302 +/- 138 mmHg in the PFC group. Arterial O2 content,
on the other
hand, increased in the blood transfused group due to an increase in hematocrit,
but fell with PFC
because of hemodilution. This lower total arterial O2 content in the PFC
group was, however,
compensated for by more efficient O2 transport by the PFC in that the
PFC arteriovenous O2
content difference accounted for 26 percent of the total arteriovenous
O2 content difference,
making it about four times as efficient as hemoglobin in tissue O2 delivery.
Fluosol DA, 20
percent, is an effective volume expander in this model of hypoxemic respiratory
failure, and it can
transport significant amounts of O2 even in the presence of a substantial
intrapulmonary shunt.
PMID: 3816321 [PubMed - indexed for MEDLINE]
Arch Inst Cardiol Mex 1986 Jul-Aug;56(4):303-7
[Accuracy of an the ear oximeter Biox-III and its sensitivity to carboxyhemoglobin
in Mexico City].
[Article in Spanish]
Perez-Padilla JR,
Bracamonte-Peraza R, Manrique G, Ruiz-Primo ME.
Ear oximeters estimate
arterial oxygen saturation (Sa02) measuring the characteristics of light
transmission through the ear lobe. We tested the accuracy of a new ear
oximeter (Biox-III) in
Mexico City comparing its estimates (Sa02OXI) with Sa02 measured by a
Co-Oximeter, in a
simultaneously taken arterial blood sample. We used two indexes in the
arterial sample: Sa02 of
the total hemoglobin (Sa02T) given directly by the Co-Oximeter and Sa02
of the hemoglobin
available for oxygenation (Sa02A) which corrects for the presence of carboxyhemoglobin
and
metahemoglobin. We studied 21 subjects with a total of 100 simultaneous
samples with a Sa02T
ranging from 36.2% to 97.2%. The samples were obtained with the subjects
resting, during light
exercise, during rebreathing and increasing the Fi02. Spearman and Pearson's
correlation
coefficients between Sa02OXI and Sa02A were 0.97, and between Sa02OXI
and Sa02T were
0.96. Lineal regression equations were: Sa02T = 2.047 (Sa02OXI) -8.5 and
Sa02A = 1.102
(Sa02OXI) -9.32. Slopes of the equations and correlation coefficients
were statistically
significant (P less than 0.001). Mean error of Sa02OXI compared with Sa02T
(Sa02T-Sa02OXI) was -4.4% and compared with Sa02A (Sa02A-Sa02OXI) was
-0.4%, with
a standard deviation of 3.4% and 3.5% respectively. In the presence of
carboxyhemoglobin the
ear oximeter overestimates Sa02T but not Sa02A. Measurement error increases
during
rebreathing maybe because error increases at low Sa02 and because of the
delay in oximeter's
response in a situation of a continuously falling Sa02.Ear oximeter Biox-III
estimates Sa02 in
Mexico City as accurately as the Biox-IIA at sea level. Sa02 measurement
is quick, easy,
continuous and non-invasive, which increase its potential clinical and
research application.
PMID: 2945522 [PubMed - indexed for MEDLINE]
Am Rev Respir Dis 1985 Aug;132(2):224-9
Breathing during sleep in patients with interstitial lung disease.
Perez-Padilla R, West P, Lertzman M, Kryger MH.
Patients with interstitial
lung disease (ILD) have a rapid shallow breathing pattern while awake
that is thought to be due to activation of lung reflexes. We wondered
whether sleep would result
in changes in respiratory control and thus cause hypoxemia and poor sleep
quality. Eleven
patients with ILD (5 men and 6 women) and 11 age- and sex-matched control
subjects were
studied during sleep. Sleep quality was worse in patients with ILD, with
more time in Stage 1
(33.7% of total sleep time (TST) versus 13.5%) and less time in REM sleep
(11.8 versus 19.9%
TST) than found in control subjects, and more fragmentation of sleep (13.7
+/- 3.1 arousals/h
and 24.3 +/- 6.0 sleep stage changes/h versus 6.9 +/- 1.0 and 12.7 +/-
1.4, respectively).
Patients with ILD with awake SaO2 less than 90% had greater abnormalities
in sleep structure
than did those with SaO2 greater than 90%. The incidence of apneas and
hypopnea periods in
patients with ILD was low (apnea plus hypoventilation index of 1.3 +/-
0.45 versus 2.9 +/- 0.82
in control subjects, p = NS). Oxygen saturation dropped during REM sleep
in patients, especially
in those with more severe awake hypoxemia. Expiratory time (Te), inspiratory
time (Ti), and their
sum (Ttot) were shorter in the patients, whereas Ti/Ttot was the same
as in control subjects. No
systematic changes during sleep were seen in these variables. The variability
of inspiratory volume
index, Ti, Te, and Ti/Ttot was similar to that in control subjects, and
was lowest during NREM
sleep. The incidence of snoring was comparable in patients and control
subjects.(ABSTRACT
TRUNCATED AT 250 WORDS)
PMID: 2411177 [PubMed - indexed for MEDLINE]
Bull Eur Physiopathol
Respir 1983 Nov-Dec;19(6):621-4
The role of protriptyline in obstructive sleep apnea.
Brownell LG, Perez-Padilla R, West P, Kryger MH.
Protriptyline, a
non-sedating tricyclic agent, was evaluated in a double blind drug-placebo
crossover trial in five obese patients with obstructive sleep apnea. Four
of the five patients had
improvement in somnolence. Protriptyline improved oxygenation. This seemed
related primarily
to a reduction (from 23% to 11%) in REM, with fewer of the more severe
REM apneas. Arousal
frequency remained quite high; thus the reason for the reduction in somnolence
remains unclear.
In three patients, at six months the improvement in clinical status and
oxygenation persisted. We
have now attempted long term treatment in nine patients. In five, anticholinergic
side-effects
necessitated stopping therapy. Four patients continue to do well. A trial
of protriptyline is thus
indicated in treatment of mild to moderate obstructive apnea or when the
patient refuses more
invasive treatment.
Publication Types:
Clinical trial
PMID: 6360257 [PubMed - indexed for MEDLINE]
Sleep 1983;6(3):234-43
Sighs during sleep in adult humans.
Sleep 1987 Jun;10(3):216-23
Perez-Padilla R, West P, Kryger MH.
We analyzed sighs
(breaths with a tidal volume at least twice that of baseline breaths)
during
sleep in 12 normal adults. We found a total of 124 sighs in the group,
with an average of 1.66
sighs/h of sleep, but with great intersubject variation (range: 1-25 sighs/night).
There were sighs in
all sleep stages, but there were more per hour in stage 1. 64.4% of the
sighs were associated
with an increase in EMG activity or EEG frequency, starting either before
or immediately after the
sigh. The remainder of the sighs were not associated with any arousal
or sleep stage changes. The
normal variability of heart rate with breathing is exaggerated during
sighs, probably because of the
greater inflation and the associated arousal. Sighs have larger mean inspiratory
flows (Vt/Ti),
expiratory flows (Vt/Te), and a larger fraction of respiratory cycle spent
in inspiration (Ti/Ttot)
than the previous breaths, all evidence of a change in respiratory control.
Sighs during sleep may
occasionally be followed by central apneas, hypoventilation, or considerable
slowing of
respiratory rate. Although it has been shown that a sigh renders the respiratory
centers refractory
to another sigh, we found that sighs sometimes occur in pairs.
PMID: 6622880 [PubMed - indexed for MEDLINE]
Lung 1996;174(5):315-23
Correlation between pulmonary fibrosis and the lung pressure-volume curve.
Sansores RH, Ramirez-Venegas A, Perez-Padilla R, Montano M, Ramos C, Becerril
C,
Gaxiola M, Pare P, Selman M.
Instituto Nacional
de Enfermedades Respiratorias, Mexico City, Mexico.
The severity of
pulmonary fibrosis is the main prognostic factor for survival of patients
with
interstitial lung diseases (ILD). Unfortunately, lung biopsy, which is
the best method to assess
fibrosis quantitatively, is done only once during the evolution of the
disease. In this study we
analyzed the relationship between the degree of fibrosis and the exponential
constant k, derived
from the lung pressure-volume curve (LPVC) in 33 patients with chronic
ILD, 19 with pigeon
breeder's disease (PBD), and 14 with idiopathic pulmonary fibrosis (IPF).
Pulmonary function
tests, including the LPVC, were obtained before biopsy. A semiquantitative
histologic assessment
of the severity of fibrosis was performed on lung tissues. All patients
showed a decrease of total
lung capacity, residual volume, compliance, and Pao2. The mean value of
the constant k was
0.08 +/- 0.06. When expressed as a percent of normal values, 25 patients
exhibited values of k
lower than 70% of predicted; of the remaining 8 patients whose values
were above 70% of
predicted, 7 had PBD and only one IPF. On morphologic analysis, 19 patients
displayed more
than 50% fibrosis. No significant correlations were found between the
extent of the lesion or
severity of lung fibrosis and the conventional pulmonary function tests.
By contrast, a moderate
but significant correlation was found between k and the severity of lung
fibrosis (r = -0.38, p <
0.05). These findings show that the shape of the LPVC, represented by
the constant k, predicts
the degree of lung fibrosis and could be useful in the clinical assessment
and follow-up of patients
with ILD.
PMID: 8843057 [PubMed - indexed for MEDLINE]
Rev Invest Clin 1995
Mar-Apr;47(2):95-101
[Capability of clinical and laboratory findings to predict the grade of
fibrosis and the diagnosis in diffuse interstitial lung diseases].
[Article in Spanish]
Perez-Padilla R, Gaxiola M, Salas J, Sansores R, Chapela R, Carrillo G,
Selman M.
Instituto Nacional
de Enfermedades Respiratorias, Mexico, D.F.
Our objective was
to assess the capacity of clinical and laboratory information to predict
findings
in the lung biopsy in interstitial lung diseases (ILD). We studied 121
patients with ILD as a cohort
recruited in our institute from 1983 to 1987 with the diagnosis of hypersensitivity
pneumonitis
(HP) and usual interstitial pneumonia (UIP). Histologic diagnosis (HP
vs UIP) and degree of
fibrosis (< 50% of the biopsy surface vs > or = 50%) were used as
the gold standard to
compare a series of clinical and laboratory variables in the initial assessment.
We used a stepwise
logistic regression model to predict the biopsy results. The model was
calculated in half of the
patients selected by random sampling, and the calculated model was tested
in the other half of the
patients. Variables found to predict degree of fibrosis were (with relative
risk RR and 95%
confidence interval): a radiographic pattern of honeycombing (RR 5.0 from
0.9-29), digital
clubbing (RR 8 from 1.4-48) and gender (RR 2.9 from 0.4-20). This model
classified correctly
72% of the biopsies, with a sensitivity of 0.38, a specificity of 0.85
and a kappa of 0.25 +/- 0.19
(p = 0.17 NS). For histologic diagnosis (NIU vs NH), the model included
gender (RR 6.6,
1.3-33), honeycombing (RR 1.6, from 0.4-6.0), digital clubbing (RR 4.6,
from 1.2-18), and vital
capacity expressed as percent of predicted (RR 0.96, from 0.92-1.00).(ABSTRACT
TRUNCATED AT 250 WORDS)
PMID: 7610289 [PubMed
- indexed for MEDLINE]
Clin Chest Med 1993 Dec;14(4):699-714
Airflow obstruction and airway lesions in hypersensitivity pneumonitis.
Selman-Lama M, Perez-Padilla R.
Clinical Research
Division, Instituto Nacional de Enfermedades Respiratorias, Tlalpan, Mexico.
Peripheral airways
of lung biopsies from patients with HP commonly show several morphologic
changes, including inflammation, fibrosis, or both. In most cases, damage
of the airways is parallel
to damage of surrounding parenchyma and the functional result is lung
restriction, perhaps with
alterations in the so-called "small airway tests." Chronic cough
and phlegm also are more
common in subjects exposed to organic antigens. Overt airflow obstruction
is present in a number
of patients with HP, and they usually have other risk factors, such as
asthma, cigarette smoking,
or dust inhalation. There are limited studies of patients who have HP
and CAO but not
concomitant risk factors for CAO, making it difficult to reach any firm
conclusion about their
association. In most cases, the lesion that could explain severe airflow
obstruction seems to be
located in bronchioles but, based on several clinical reports, there is
the possibility that HP
occasionally ends in emphysema.
Review
Review, tutorial
PMID: 8313674 [PubMed - indexed for MEDLINE]
Am Rev Respir Dis
1993 Jul;148(1):49-53
Mortality in Mexican patients with chronic pigeon breeder's lung
compared with those with usual interstitial pneumonia.
Perez-Padilla R, Salas J, Chapela R, Sanchez M, Carrillo G, Perez R, Sansores
R,
Gaxiola M, Selman M.
Instituto Nacional
de Enfermedades Respiratorias, Mexico City, Mexico D.F.
The clinical course
of chronic pigeon breeder's lung (CPBL) is unknown, especially in
comparison with usual interstitial pneumonia (UIP). We studied a cohort
of 125 consecutive
patients with interstitial lung diseases, including 78 patients with CPBL
(74 biopsied) and 47
patients with UIP in the lung biopsy. Patients with UIP were divided into
17 without bird
exposure (UIP) and 30 with bird exposure (UIP + BE). All patients were
treated with
corticosteroids and followed for 33 +/- 23 months. The best predictors
of mortality (Cox
proportional hazards model) were age > 44 yr, with a relative risk
(RR) of 2.5 and 95%
confidence interval (CI) of 1.4 to 4.7, masculine gender (RR 4.0, CI 2.1
to 7.6), x-ray
honeycombing (RR 7.0, CI 3.8 to 12.7), and severity of fibrosis in the
lung biopsy (RR 4.8, CI
2.3 to 9.7). Survival in CPBL 5 yr after diagnosis was 0.71 (SEM 0.08)
and in UIP was 0.23
(SEM 0.08), with no statistical difference between UIP + BE and UIP. After
adjusting for
severity of fibrosis and honeycombing, however, the correlation of diagnosis
with survival
disappeared. In conclusion, mortality in CPBL is considerable, but lower
than in UIP. Lung
fibrosis and honeycombing seem to be a final common pathway for the ILD.
Adjusting for them,
the effect of diagnosis in survival is not significant.
PMID: 8317813 [PubMed - indexed for MEDLINE]
Am Rev Respir Dis
1993 Mar;147(3):635-44
Characteristics of the snoring noise in patients with and without occlusive
sleep apnea.
Perez-Padilla JR, Slawinski E, Difrancesco LM, Feige RR, Remmers JE, Whitelaw
WA.
Department of Medicine, University of Calgary, Alberta, Canada.
We analyzed snoring
noise from 10 nonapneic heavy snorers and nine patients with obstructive
sleep apnea (OSA). Sound was recorded simultaneously through two microphones,
one attached
to the manubrium sterni and one suspended in the air 15 cm from the patient's
head. Signals were
stored on magnetic tape, digitized, and displayed in the time and frequency
domains. Most of the
power of snoring noise was below 2,000 Hz, and the peak power was usually
below 500 Hz.
When snores were generated during nose-only breathing (nasal snores),
the sound spectrum was
made up of a series of discrete, sharp peaks, with a fundamental note
and harmonics similar to
the spectrum of voiced sounds. When snores were generated during breathing
through nose and
mouth (oronasal snores), the spectra showed a mixture of sharp peaks and
broad-band white
noise. Patients with apnea showed a sequence of snores with spectral characteristics
that varied
markedly through an apnea-respiration cycle. The first postapneic snore
consisted mainly of
broad-band white noise with relatively more power at higher frequencies,
so that the ratio of
power above 800 Hz to power below 800 Hz could be used to separate snorers
from patients
with OSA. Other breaths in the cycle resembled oronasal or nasal snores
in nonapneic subjects.
Characteristics of the noise give information about the possible mechanism
of sound generation
and thus about the behavior of the pharynx during snoring. Quality of
snoring sound may help to
separate patients with obstructive apnea from those with simple snoring.
PMID: 8442599 [PubMed - indexed for MEDLINE]
Rev Invest Clin 1992 Jul-Sep;44(3):353-62
[Gasometric values reported in healthy subjects from the Mexican
population: review and analysis].
[Article in Spanish]
Perez Martinez SO, Perez-Padilla JR.
Departamento de
Fisiologia Pulmonar, Instituto Nacional de Enfermedades Respiratorias,
Mexico, D.F.
We do not know the
normal relationship between altitude and PaCO2 in Mexico. We collected
and analyzed the reports of reference values for gasometry in Mexico City
(2240 m above sea
level and a mean barometric pressure of 585 Torr) and other places in
the country. The reports
include arterial, capillary and expired gases in children and adults,
with measurements done in
resting and exercising subjects, breathing room air and 100% oxygen. In
Mexico City we found
18 studies in normal subjects reporting a mean PaCO2 ranging from 25.5
to 38.4 Torr.
Averaging arterial studies from children and adults, adjusting for the
number of subjects studied,
and discarding data with mean pH below 7.37 or above 7.43 (suggesting
non steady state), 10
studies with a total of 581 subjects have the following average values
(Torr, means and SD):
PaCO2 = 31.1 +/- 2.6, PaO2 = 67.7 +/- 2.6, calculated PAO2 and P(A-a)O2
73.6 +/- 3.3 y
6.1 +/- 3.7 respectively. The PaCO2 found was much lower than that reported
for native
Peruvians in the Andes who have a mean PaCO2 of 37.8 Torr at an altitude
of 2390 m, and a
mean PaCO2 of 33.0 Torr only at 4860 m above the sea level. On the other
hand, the average
values in Mexico are similar to those found in North Americans who have
a mean PACO2 of
33.1 Torr at 2131 m of altitude, a mean PACO2 of 30.7 at 2371 m and a
mean PaCO2 of 31
Torr at 2238 m. Normal values for gasometry in Mexico are scarce and some
of the existing
ones are erroneous probably due to lack of adequate calibrations and to
poor quality control.
Values of PaCO2 in Mexico are more similar to those found in the USA than
to those found in
Peruvian natives.
Publication Types:
Meta-analysis
PMID: 1488580 [PubMed - indexed for MEDLINE]
Chest 1992 Jun;101(6):1691-3
Prevalence of high hematocrits in patients with interstitial lung disease
in
Mexico City.
Perez-Padilla R, Salas J, Carrillo G, Selman M, Chapela R.
Instituto Nacional de Enfermedades Respiratorias, Mexico City.
Erythrocytosis,
a known response to chronic hypoxemia, is considered infrequent in interstitial
lung diseases. We studied the prevalence of high hematocrit (Hct) values
and the relationship
between Hct and SaO2 in 79 patients with chronic pigeon breeder's lung
(PBL) and 34 with
idiopathic pulmonary fibrosis (IPF), all of whom lived in the Mexico City
metropolitan area
(2,240 m above sea level). Lung biopsy was performed in 31 patients with
IPF and 71 with
PBL. We analyzed only one simultaneous measurement of Hct and SaO2 per
patient (usually the
initial measurement) before treatment. No additional cause for anemia
or erythrocytosis was
detected. Forty-eight percent of the patients with PBL (38/79) and 62
percent of those with IPF
(21/34) had high Hct values (greater than 2 SD above mean values for Mexico
City); in 14 (12.3
percent) of the 113 patients (nine with PBL and five with IPF), the Hct
was above 60 percent.
The Hct and SaO2 values displayed a poor correlation for the whole group:
Hct =
65.7-0.16(SaO2), r = 0.24, p = 0.012. The correlation between Hct and
SaO2 was
nonsignificant if patients were separated by diagnosis. For an SaO2 of
less than 80 percent, the
slope of SaO2 vs Hct was zero. Half of our patients with PBL and IPF had
Hct values that were
high for the altitude. In most cases, Hct responses fell within the confidence
limits reported as
normal at high altitudes. We found a poor relationship between Hct and
awake SaO2.
PMID: 1600793 [PubMed - indexed for MEDLINE]
Chest 1992 May;101(5):1352-6
Exponential analysis of the lung pressure-volume curve in patients with
chronic pigeon-breeder's lung.
Sansores R, Perez-Padilla R, Pare PD, Selman M.
Departamento de
Fisiologia Pulmonar, Instituto Nacional de Enfermedades Respiratorias
(INER), Mexico City.
Pigeon-breeder's
lung (PBL) is extremely common in Mexico City and often progresses to
irreversible pulmonary fibrosis. The exponential analysis of the lung
pressure-volume (PV) curve
(V = A - Be-kp) has been suggested as a method to separate the lung restriction
caused by
inflammation from that caused by pulmonary fibrosis; a significantly decreased
value for the
exponential constant, k, suggests a change in the mechanical properties
of the functioning lung
parenchyma, while a normal value accompanied by restriction suggests subtraction
of lung units
without a change in the mechanical properties of the functioning units.
We measured lung volumes
and static PV curves in 29 patients who had persistent lung restriction
following a biopsy-proven
diagnosis of PBL. Mean values in the 29 subjects were as follows: age,
43 +/- 13 years; TLC,
61 +/- 15 percent of predicted; VC, 46 +/- 19 percent of predicted; and
k, 55 +/- 17 percent of
predicted. Twenty-four of the 29 patients had values for k that were below
the 95 percent
confidence level, and five had "normal" values. There was no
difference in TLC and VC (percent
of predicted) between those with or without a decreased value for k. Four
of five patients with a
normal value for k improved subsequent to diagnosis, while only one of
21 patients with a
decreased k improved. We conclude that increased lung elasticity manifested
by a low value for
k is common in patients with chronic PBL. These results support the observation
of frequent
irreversible lung fibrosis in these patients. Measurements of k could
prove a good prognostic
indicator at the time of initial diagnosis.
PMID: 1582296 [PubMed - indexed for MEDLINE]
Chest 1991 Jan;99(1):152-4
Behavior of the pulmonary circulation at rest and during exercise in
miliary tuberculosis.
Sandoval J, Cicero R, Seoane M, Perez-Padilla R, Quesada A, Lupi-Herrera
E.
Cardiopulmonary Service Instituto Nacional de Cardiologia Ignacio Chavez,
Mexico City,
Mexico.
We studied the hemodynamic
behavior of the pulmonary circulation at rest and during exercise in
six patients with MTB. As a group, in contrast to advanced fibrocaseous
tuberculosis, these
patients exhibited normal pulmonary hemodynamics at rest and during exercise.
Only minor
abnormalities in pulmonary vascular resistance at exercise (increased
PAd-PWP gradient) were
noted in two of the patients. The increase in Rp during exercise does
not appear to be related to
acute hypoxic vasoconstruction but rather to functional changes (compliance
or recruitment or
both) of the pulmonary microvasculature. In the genesis of these functional
changes, chronic
alveolar hypoxia and the inflammatory-fibrotic process might be interacting.
PMID: 1984947 [PubMed - indexed for MEDLINE]
Rev Invest Clin 1991 Jan-Mar;43(1):87-98
[The challenge of evaluating clinical competence].
[Article in Spanish]
Viniegra L, Jimenez JL, Perez-Padilla JR.
Division de Estudios
de Posgrado e Investigacion, Facultad de Medicina, UNAM.
The study is divided
in two parts. The first one deals with theoretical aspects of evaluation.
In the
second part, the development of an instrument intended to explore clinical
competence is
presented. The importance of considering evaluation as part of a research
process is emphasized
in the first part. The diverse theoretical and action trends in the field
of education are synthetized
in two main tendencies: the active-participating and the passive-receptive.
The influence of these
two tendencies in the selection the objects for evaluation is also discussed.
An evaluation
instrument developed by us to explore clinical competence is placed within
the
active-participating tendency of education; the present state of this
instrument is given in the
second part. The instrument consists of multiple choice options of the
true, false, don't know
type. The instrument in its present version is the result of a long validation
process. It explores
particularly iatrogenic behaviors by omission or commission. The sample
studied were 457
applicants for specialization courses in medicine. Of these, 127 were
foreign applicants. The
instrument was applied to the whole sample in one single session. The
results showed a low
general clinical competence, with similar results in mexican and foreign
applicants. A clear
difference was found in commission iatrogenia which was significantly
more frequent than
omission iatrogenia. The theoretical superiority of our test in relation
the others is discussed
Salud Publica Mex
1990 Jan-Feb;32(1):3-14
[Ethical attitudes related to problems of managing patients with acquired
immunodeficiency syndrome].
[Article in Spanish]
Perez-Padilla JR, Ponce de Leon-Rosales S.
Departamento de
Fisiologia Pulmonar del Instituto Nacional de Enfermedades Respiratorias.
We evaluated, with
a questionnaire, ethical attitudes towards the clinical attention of patients
with
AIDS in 88 physicians. Most of the surveyed were residents and all were
working in two
mexican hospitals with experience managing patients with AIDS: The National
Institute of
Nutrition and the National Institute of Respiratory Diseases. None of
the questions was answered
similarly by all physicians and some of them considered ethically unquestionable,
behaviours that
traditionally are immoral or even illegal. Reproducibility of the results,
evaluated in 10 doctors 5
months later, was acceptable. Ethical attitudes were heterogeneous and
inconsistent in the
surveyed. This can be the results of a poor or absent training in Medical
Ethics in medical schools
and during residencies. We believe this deficiency helps maintaining discriminatory
attitudes
against patients with AIDS and may decrease the quality of medical services
to the group.
PMID: 2330511 [PubMed - indexed for MEDLINE]
J Appl Physiol 1989
Dec;67(6):2257-64
Rapid shallow breathing caused by pulmonary vascular congestion in cats.
Hatridge J, Haji A, Perez-Padilla JR, Remmers JE.
University of Texas Medical Branch, Galveston 77550.
The vasculature
of one lung of unanesthetized spontaneously breathing decerebrate cats
was
isolated and congested with blood. Such pulmonary vascular congestion
(PVC) consistently
resulted in a shallow tachypnea associated with expiratory activation
of the diaphragm and
thyroarytenoid muscles, signifying augmented expiratory braking. With
progressive increases in
pulmonary vascular pressure, tachypnea and expiratory braking increased
progressively and
ultimately obscured phasic activity in the diaphragm and thyroarytenoid.
Thus the apnea caused
by PVC constitutes not an arrest of neural respiratory activity but rather
a continuous activation
of thoracic inspiratory and laryngeal adductor muscles. When capsaicin,
a neurotoxin that
activates nonmyelinated afferents, was injected into the pulmonary artery
of the isolated lung, it
produced changes in timing and distribution of respiratory motor output
that resembled those with
PVC but were more abrupt in onset. Capsaicin, applied perineurally to
the cervical vagi,
preferentially blocked the conduction of nonmyelinated afferent fibers.
This procedure, which
produced little degradation in Hering-Breuer reflexes, eliminated tachypnea
and expiratory
braking caused by PVC or capsaicin injection. The results indicate that
activation of pulmonary
vagal afferent fibers of C or A-delta category in unanesthetized cats
reflexly modifies the
respiratory motor output in a way that resembles the human response to
PVC or pulmonary
embolism. This is a brain stem reflex.
PMID: 2606831 [PubMed - indexed for MEDLINE]
Rev Invest Clin 1989
Oct-Dec;41(4):375-9
[Method for calculating the distribution of randomly expected scores in
a
false-true-do not know-type of test].
[Article in Spanish]
Perez-Padilla JR, Viniegra Velazquez L.
Multiple choice tests have been used widely in the evaluation of knowledge.
The lowest passing
limit is generally chosen arbitrarily. Better and more objective criteria
may arise from analyzing the
distribution of correct and incorrect answers as expected by chance. In
order to calculate the
distribution of correct answers and the difference between correct and
incorrect answers (core)
we propose the use of a method based on a gaussian distribution. The distribution
of scores
expected by chance is approximated by a gaussian distribution with a mean
of zero and a
standard deviation SD = square root of n(pA + pE), and the distribution
of the total number of
correct answers has a mean of npA and SD = square root of npApE, where
n is the total number
of questions, and pA and pE are the probabilities of having a correct
and an incorrect answer,
respectively. The formulae are applicable to questions type false/true/do
not know and to the
more common type of one correct in five options. Once the chance distribution
is known, it can
be compared with the distribution of scores or correct answers obtained,
which can then be used
to separate people in two groups: those that answer the test as expected
or worse than expected
by chance, and those that answer the test better than expected by chance.
The first group should
not be passed. The passing of individuals in the second group can be decided
by additional
criteria.
PMID: 2631171 [PubMed - indexed for MEDLINE]
Rev Invest Clin 1989
Jul-Sep;41(3):209-13
Rating of breathlessness at rest during acute asthma: correlation with
spirometry and usefulness of breath-holding time.
Perez-Padilla R, Cervantes D, Chapela R, Selman M.
We studied 13 patients with acute attacks of asthma to test the hypothesis
that magnitude of
dyspnea at rest correlates well with spirometry and with breath-holding
time. Dyspnea ("falta de
aire" in Spanish) was quantitated with a linear numerical scale from
0 to 10. We measured
breath-holding time, breathing frequency (f), and FEV1 and FVC both expressed
as percent of
normal. Measurements were done on the patient's arrival and were repeated
3 to 6 times until
dyspnea at rest disappeared or was minimal. Dyspnea magnitude, f, and
breath-holding time
correlated well with FEV1% and FVC% (r between 0.65 and 0.78), and better
with changes in
FEV1% and FVC% with respect to initial values (delta FEV1 y delta FVC;
r between 0.80 and
0.89). Breath-holding time and f changed in proportion to magnitude of
dyspnea (r = -0.85 and
0.87 respectively). Regression equations were: dyspnea = 6.34 -0.16 (delta
FEV1) r = 0.80,
and dyspnea = 7.82-0.105 (FEV1%) r = 0.62. Using multiple regression we
improved
prediction of FEV1% with easily obtained variables (R = 0.76). These results
suggest that: 1)
magnitude of dysnea, f, and breath-holding time correlate with severity
of airflow obstruction in
acute asthma attacks associated with dyspnea at rest; and 2) breath-holding
time varies inversely
with dyspnea magnitude when it is present at rest.
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