Obrador, Gregorio

Main Affiliation

Facultad de Ciencias de la Salud - CampCM

Preferred name

Obrador, Gregorio

Official Name

Tomás Obrador Vera, Gregorio

ORCID

0000-0003-3814-7449

Researcher ID

B-3054-2011

Scopus Author ID

6602806471

Now showing 1 - 10 of 76

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Epidemiology of Kidney Disease in the Elderly
(Springer Nature Switzerland, 2024)
Obrador, Gregorio
Concomitant with population aging, kidney disease incidence and prevalence among the elderly is growing globally. The prevalence of chronic kidney disease (CKD) increases with age and is higher in women than in men. Impaired kidney function in older people is associated with adverse outcomes. Older people are more likely to die than to reach kidney replacement therapy. Discontinuation of maintenance dialysis is frequent and a leading cause of death. Kidney transplant recipients in recent years are older than in the past on average. Conservative kidney management is an alternative therapy for end-stage kidney disease, and is especially suited for older patients with multiple comorbid conditions. Elderly patients have many risk factors for developing acute kidney injury, increasing the risk of chronic kidney disease, kidney failure, and mortality. The prevalence of glomerular diseases in the elderly is growing and faces significant diagnostic and therapeutic challenges. © The author © Springer.
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Pain reduction with VR in indigenous vs urban patients in ambulatory surgery
(2019)
Mosso Vázquez, José Luis
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Obrador, Gregorio
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Moss Lara, Dejanira
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Mosso Lara, José Luis
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Wiederhold, Brenda K.
The current report presents comparisons of pain reduction and heart rate response using supplemental virtual reality (VR) pain distraction between 22 indigenous and 22 urban patients during ambulatory surgery. Material and methods. Forty-four (44) patients participated under full informed consent. Half (n = 22) were indigenous peoples and half (n = 22) were urban patients (those residing in Mexico City). For the urban group, a surgeon performed ambulatory surgeries with local anesthesia to remove lesions in soft tissues, such as lipomas, cysts located in the head, neck, back, shoulders, arms, limbs, and abdomen. For the indigenous group, operating rooms, intravenous line, analgesics, and sedatives were not used. Materials included laptop-linked virtual reality, PlayStation, Smartphones and Google Cardboard googles alongside virtual environments such as Enchanted Forest, The Sea, Lake Valley, Jurassic Dinosaur and Coast Space VR. Results. Pain scale indicated 2.92 before, 1.67 during and 0.67 after for indigenous participants, and 5.8 before, 3.32 during and 1.48 after for urban participants. Heart rate responses in indigenous were 80.42(before), 78.5 (during) and 72.42 (after) and urban responses were 74.07 (before), 68.53 (during) and 73.1(after). Discussion. Indigenous patients presented more pain reduction during ambulatory surgery without intravenous lines, analgesics or sedatives and required recovery time or hospitalization. Supplemental VR during medical and surgical procedures is discussed in light of cultural, economic and psychological variables associated with medical care in Mexico. ©2019, Interactive Media Institute. All rights reserved.
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Cybertherapy in Medicine – Experience at the Universidad Panamericana, IMSS and ISSSTE Mexico
(2012)
Mosso Vázquez, José Luis
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Wiederhold, Brenda
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Wiederhold, Mark
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Obrador, Gregorio
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Lara, Verónica
There are many reports of Virtual Reality analysis and clinical applications in Medicine since the end of the last century for many authors. In trauma head injuries [1], during chemotherapy in children [2], in burn wound care [3,4,5], lumbar puncture [6,], breast cancer [7], vein puncture [8], pain distraction [9,10,11,12], dental pain control [13], leg ulcer relief [14], night vision technology with robot control to treat bourn injuries using robot-like arm mounted VR goggles [15]. The first case reports related with VR and medical invasive procedures and surgery in hospitals was in 2004 with our group, beginning with upper gastrointestinal endoscopies and so on, until introduce VR in postoperative care unit of cardiac surgery [16,17]. Pain and anxiety in outpatients and inpatients is a regular symptom in hospitals. For pain are available medications and for anxiety also. Patients in; in-rooms, operating rooms and another different places, get treatments with medical and surgical procedures, and pain and anxiety are the meanly symptom. In this project we try to demonstrate that virtual reality is a complementary tool to reduce pain and anxiety in hospitals during medical procedures including surgical procedures. There are a lot reason and justifications to use VR in hospitals, as follows. Neonatology (0-28 days old), there are newborns staying in unit cares since few days, weeks even months, growing without contact with the external world. The visit unit care is limited to parents in few hours a day. The psychological impact in growth and development in childhood is so hard, where neuro stimulation in a closed environment is a good alternative. In Infants (lower and higher infants) VR have been a good resource to reduce pain and anxiety in oncology. Hunter Hoffman has demonstrated in the benefits of VR during medical rehabilitation in burned childhood. In postoperative cardiac surgery unit care, patients stay 3 days in different critical care units depending of their progress. In these units they stay under the influence of sedative drugs receiving treatments by vein catheters, gastric tube, etc. Their recovery is on beds with different degrees of limited position and the breathing relief is on bed also. In ambulatory surgery (General surgery, endoscopic surgery, urology, dermatology, Orthopedic, angiology, pediatric surgery, obstetrics), patients are awake, minutes, even hours awake during surgical procedures doing nothing in a same position on a surgical table. In the recovery they stay hours waiting for go home or to be hospitalized. Special group of ambulatory surgery, surgeon used night vision technology while patients navigate in VR environment. At the school of medicine from Universidad Panamericana we used night vision on animal models before the application on humans. Gynecology and obstetrics. Women during colposcopy are awake while gynecologist applies local anesthesia into the cervix to perform cervical conization with diathermal loop. The anxiety is present in a same gynecological position. Gastrointestinal endoscopy. Under local anesthesia, neurovegative response is present during and after each upper gastrointestinal exploration of esophagus, stomach and duodenum. Patients present plenty of saliva associated with shortness of. Labor Room. Pregnant patients without complications expected hours to complete cervical dilation in labor room to go into delivery room or operating room. During uterus contractions they increase their respiratory rate. Pediatric. Scholar children stay on bed many days in recovery. In their stay they distract with games and in some times with a TV only. Epidural and Spinal block in anesthesia. This is a relative fast procedure compared with the previous groups where patient in the fetal position they expect catheter installation in their back, place where they can´t see anything and anxiety is present despite local infiltration.
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Hospital utilization among chronic dialysis patients
(2000)
Arora, Pradeep
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Kausz, Annamaria T.
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Obrador, Gregorio
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Ruthazer, Robin
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Khan, Samina
Factors driving inpatient and outpatient utilization were studied among patients who began dialysis for chronic renal failure at the New England Medical Center (NEMC) between 1992 and 1997. Clinical, laboratory, and hospital resource utilization data were obtained from patient records and electronic databases. There were 2.2 hospitalizations and 14.8 hospital days per patient year at risk (PYAR). The number of hospitalizations and hospital days per PYAR were higher in the first 3 mo of initiating dialysis (4.3 and 28.3, respectively) compared to after 3 mo (1.9 and 12.9, respectively). Factors associated with increased risk of hospital days within the first 3 mo included non-health maintenance organization insurance, ischemic heart disease, late referral to the nephrologist, and use of temporary vascular access for the first dialysis. Patients with ischemic heart disease and who received dialysis during the years 1992-1994 compared with 1996-1997 had an increased risk of hospital days after 3 mo of initiating dialysis. There were 16.6 outpatient visits per PYAR, with significant differences in utilization between the first 3 mo and after 3 mo of initiating dialysis. Thus, hospital utilization was significantly higher in the first 3 mo compared to after 3 mo, and factors associated with hospital utilization depended on duration of dialysis. In particular, delayed referral to the nephrologist and lack of permanent vascular access were independently associated with increased risk of hospital utilization in the first 3 mo of dialysis. Greater attention to timely referral to the nephrologist and timely placement of vascular access could result in reduced utilization and cost savings.
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Chronic Kidney Disease in Children Aged 6–15 Years and Associated Risk Factors in Apizaco, Tlaxcala, Mexico, a Pilot Study
(2019)
Ortega-Romero, Manolo
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Méndez-Hernández, Pablo
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Cruz-Angulo, María del Carmen
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Hernández-Sánchez, Ana María
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Álvarez-Elías, Ana Catalina
Introduction: Tlaxcala, a small state in central Mexico, has the highest prevalence of chronic kidney disease (CKD) deaths in population aged 5-14 in Mexico, most of them with unknown etiology. Objective: To determine the prevalence of CKD in apparently healthy pediatric population in Apizaco, Tlaxcala. Methods: A cross-sectional pilot study was carried out in children deemed as healthy; subjects with previous diagnosis of CKD were excluded. Informed consent was obtained in all cases. A physical examination was performed, a questionnaire was applied. Blood and urine samples were obtained for serum creatinine, urinalysis, and microalbumin/creatinine ratio. A second and third evaluation was performed after 6 and 18 months in those found with urinary anomalies/CKD to confirm the diagnosis. Results: One hundred and nine subjects completed physical examination, which are the biological samples. Median age was 12 years. CKD stage 2 was confirmed in 5 subjects in the sixth month confirmation visit (4.6%). One patient accepted renal biopsy and Alport Syndrome was found. In a robust multivariate analysis, the risk factors related to reduction in the glomerular filtration rate were males -5.15 mL/min/1.73 m2 (p = 0.002), older participants as by -1.58 mL/min/1.73 m2 per year (p < 0.0001), and among participants living close to a river -3.76 mL/min/1.73 m2 (p = 0.033). Discussion/Conclusion: The prevalence of CKD in the population studied in Apizaco Tlaxcala was confirmed in 4.6 cases per 100 inhabitants between 6 and 15 years. Males, older age, and living close to a river were the risk predictive factors. More studies are needed to determine the causes of the high CKD prevalence in this population. ©2019 S. Karger AG, Basel.
Scopus© Citations 7 23 1
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Decreased kidney function and agricultural work: a cross-sectional study in middle-aged adults from Tierra Blanca, Mexico
(2020)
Aguilar-Ramirez, Diego
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Raña-Custodio, Alejandro
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Olvera, Nadia
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Rubilar, Ximena
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Escobar, Alejandro
Background: We aimed to determine the prevalence of decreased kidney function in a potential chronic kidney disease (KD) of unknown aetiology hotspot in Mexico, assess its distribution across occupations and examine the associated risk factors. Methods: A cross-sectional study collected sociodemographic, occupational, medical and biometric data from 616 men and women aged 20-60 years who were residents of three communities within the Tierra Blanca region in Mexico. Kidney function was assessed by standardized serum creatinine and estimated glomerular filtration rate (eGFR) and semi-quantitative albumin-to-creatinine ratio (ACR). To examine the distribution of decreased kidney function within the population, age- and sex-adjusted prevalence of low eGFR (≤60 mL/min/1.73 m2) was estimated for all participants and across occupations. Multivariable logistic regression was used to assess the association of occupation with having low eGFR.
Scopus© Citations 16 22 1
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Resumen de las Guías de práctica clínica KDIGO sobre el cuidado del receptor de trasplante renal
(Sociedad Argentina de Nefrología Argentina, 2011)
Kasiske, Bertram L.
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Zeier, Martin G.
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Chapman, Jeremy R.
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Craig, Jonathan C.
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Ekberg, Henrik
La guía de práctica clínica 2009 Enfermedad Renal: Mejorando los Resultados Globales (KDIGO, por sus siglas en inglés) sobre el control, manejo y tratamiento de receptores de un trasplante renal, está destinada a ayudar al cuidado médico de adultos y niños después de un trasplante renal. El proceso de desarrollo de la guía se ha hecho con un enfoque basado en la evidencia y las recomendaciones sobre manejo se fundamentan en revisiones sistemáticas de ensayos clínicos relevantes sobre el tratamiento. La valoración crítica de la calidad de la evidencia y la fuerza de las recomendaciones se basan en los Grados de Recomendación, Valoración, Desarrollo y Evaluación (GRADE, por sus siglas en inglés). La guía ofrece recomendaciones para la inmunosupresión y el monitoreo del injerto, así como para la prevención y el tratamiento de infecciones, enfermedades cardiovasculares, neoplasias y otras complicaciones frecuentes en el receptor de un trasplante renal, como los trastornos hematológicos y óseos. Se discuten las limitaciones de la evidencia, especialmente debidas a la falta de resultados definitivos en ensayos clínicos, y se proporcionan sugerencias para futuras investigaciones. Este resumen contiene una breve descripción de la metodología y de las recomendaciones completas de las guías, pero no contiene la justificación y las referencias de cada recomendación, las cuales han sido publicadas en otra revista. ©Revista de nefrología, diálisis y transplante, Sociedad Argentina de Nefrología Argentina.
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How important is transfusion avoidance in 2013?
(2013)
Macdougall, Iain C.
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Obrador, Gregorio
Prior to the advent of recombinant erythropoietin in the late-1980s, blood transfusions were the mainstay of anaemia management in patients with end-stage renal failure, many of whom required “top-up” transfusions every 2 to 4 weeks to relieve the debilitating symptoms of severe anaemia. Erythropoietin therapy, however, allowed for the first time, such patients to achieve a sustained correction of anaemia, and there was a dramatic fall in both the use of red cell transfusions in dialysis units, as well as the associated transfusional iron overload prevalent in dialysis patients. Avoidance of blood transfusions improved access to, and outcomes of, kidney transplantation, due to reduced HLA sensitization. In recent years, however, there have been safety concerns regarding the use of erythropoiesis-stimulating agents (ESAs), and there are signs that the use of blood transfusions is once again increasing. The aim of this review is to reassess how important transfusion avoidance is in 2013, and whether we should still have the same concerns about HLA sensitization that we had 20 years ago. ©Nephrology Dialysis Transplantation.
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Chronic Kidney Disease in the United States: An Underrecognized Problem
(2002)
Obrador, Gregorio
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Pereira, Brian J.G.
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Kausz, Annamaria T.
The continued growth of the population with end-stage renal disease (ESRD) is partially related to the underrecognition of earlier stages of chronic kidney disease (CKD) and risk factors for the development of CKD. There are several published estimates of the prevalence of CKD in the United States. From Third National Health and Nutrition Examination Survey data it has been estimated that there are 6.2 million individuals with serum creatinine levels at or above 1.5 mg/dL, or 8.3 million individuals with decreased glomerular filtration rate (<60 mL/min/1.73 m (2)). Estimates of prevalence from a health maintenance organization study suggest that there are 4.2 million Americans with persistently elevated serum creatinine levels. In addition to the high prevalence, several studies have shown that CKD is associated with increased risk for cardiovascular disease, hospitalizations, and mortality. To promote earlier detection of CKD, The National Kidney Foundation Guidelines for CKD: Evaluation, Classification and Stratification, recommended screening individuals at increased risk for CKD, such as patients with diabetes, high blood pressure, and family history of kidney disease. Therapeutic interventions to delay progression and reduce comorbidity, such as cardiovascular disease, are more likely to be effective if they are implemented early in the course of CKD. Copyright 2002, Elsevier Science (USA). All rights reserved.
Scopus© Citations 68 13 1
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Prevalence of Malnutrition in Low-Income Mexican CAPD Patients
(2003)
García-García, Guillermo
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Nuñez-Martinez, Maria Guadalupe
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Obrador, Gregorio
Malnutrition is a common finding in continuous ambulatory peritoneal dialysis (CAPD) patients (1-6) and has been shown to be associated with increased morbidity and mortality (5). Identified risk factors are diabetes mellitus and female gender, nutritional status at the start of therapy, length of time on dialysis, age, and residual renal function (1,4,7,8). The reported prevalence in developed countries varies from 18% to 55% (1-3,5,6). In Mexico, it has been reported that 82% of CAPD patients show some degree of malnutrition (4). Socioeconomic factors and diabetes mellitus might contribute to the problem, since reduced income limits the availability of food. Our program provides CAPD to patients from the lowest social strata in Mexico. The average annual income in our state is US$1,775 and the prevalence of malnutrition is 25% (9). Our patients’ annual income per capita ranges between US$30 and US$430. (10). Diabetes mellitus is the main cause of end-stage renal disease (ESRD) in our state, representing 40% of our prevalent CAPD population (11). In this study, we report the prevalence of malnutrition among low-income Mexican CAPD patients and compare results with other series. Copyright © by International Society for Peritoneal Dialysis
Scopus© Citations 7 26 2

Obrador, Gregorio

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