Heart Failure Pilot Survey by the Uruguayan-European Survey Group (GUERNICA)

Aims: Uruguayan branch (GUERNICA) of the ESC-HF Pilot Survey main objectives are: a) to test the tool in order to constitute a permanent registry; b) to characterize the epidemiology of heart failure(HF) patients (p); c) to describe the diagnostic and therapeutic processes applied, and d) to compare b and c with those of the ESC countries as a whole. Methods and results: GUERNICA is a prospective, multicentre, observational study. All outpatients with chronic HF or admitted for acute heart failure were included during the enrolment period, 1 day per week, 11 consecutive months, February 2010-January 2011. In 8 centres, 258p were recruited. Compared to the ESC countries, more ambulatory patients (88.4% vs. 63%, OR 4.46 CI 95% 3.03/6.55) predominantly NYHA functional class I-II (88.6% vs. 71.7% OR 3.05 CI 94% 2.01/4.01) were recruited. There were no differences in the most frequent aetiology, ischaemia, and ejection fraction (35%), with a similar percentage of beta-blockers and ACE-I/ARB use (79.8%). Neither were there any in most invasive procedures except in cardioverter-defibrillators implantation rate (1.75% vs. 13.27%, OR95%CI 0.12[0.04-0.31]). There was a lower mean SBP (122 ±29 vs. 133 ± 29, p 0.0359), more frequent renal failure (59.1% vs. 24.2%, OR 95%CI 4.53[1.92/10.68] and use of inotropic drugs (23.33% vs. 10.39%, OR 95% CI 2.62 [1.11/6.19] among hospitalized patients in our country.Conclusion: GUERNICA is a useful tool to approach epidemiology and management of HF, confirming the feasibility of setting up a permanent registry. The clinical epidemiology and the diagnostic and therapeutic process of both groups were comparable, with some differences analysed.

Objetivos: los principales objetivos de la rama uruguaya (GUERNICA) del Estudio Piloto de Insuficiencia Cardíaca de la Sociedad Europea de Cardiología (ESC-HF Pilot Survey) son: a) probar la herramienta en vistas a constituir un registro permanente; b) caracterizar la epidemiología de los pacientes con insuficiencia cardíaca (IC); c) describir el proceso diagnóstico y terapéutico aplicado, y d) comparar b y c con los correspondientes a los de los países de la ESC en su conjunto.Métodos y resultados: GUERNICA es un estudio prospectivo, multicéntrico, observacional. Todos los pacientes ambulatorios con IC crónica o los internados por IC aguda fueron incluidos durante el período de enrolamiento, que fue de un día por semana durante 11 meses consecutivos (febrero de 2010-enero de 2011). En ocho centros fueron reclutados 258 pacientes. Comparado con los países de la ESC, fueron reclutados más pacientes ambulatorios (88,4% versus 63%, OR 4,46 IC 95% 3,03/6,55), predominando en los ambulatorios la clase funcional I-II de la NYHA (88,6% versus 71,7% OR 3,05 IC 94% 2,01/4,01). No hubo diferencias en la etiología más frecuente que fue la isquemia ni en la fracción de eyección del ventrículo izquierdo con un porcentaje similar (35%). El uso de betabloqueantes e inhibidores de la enzima convertidora de angiotensina y antagonistas de receptores de angiotensina II fue también similar en los pacientes ambulatorios (79,8%). Tampoco las hubo en la mayoría de los procedimientos invasivos, excepto en el rango de cardiodesfibriladores (1,75% versus 13,27%, OR 95% IC 0,12 [0,04-0,31]). Hubo una menor presión arterial sistólica media (122 ± 29 versus 133 ± 29, p 0,0359), mayor frecuencia de insuficiencia renal (IR) (59,1% versus 24,2%, OR 95% IC 4,53 [1,92/10,68]) y de uso de fármacos inotrópicos (23,33% versus 10,39%, OR 95% IC 2,62 [1,11/6,19] en los pacientes hospitalizados en nuestro país.

Insulin-mediated pseudoacromegaly and ovarian insufficiency via a single enzymatic defect: a case report

Insulin resistance is a condition in which the cells of the body become resistant to the effects of insulin, that is, the normal response to a given amount of insulin is reduced. As a result, higher levels of insulin are needed in order for insulin to exert its effects. Polycystic Ovarian Syndrome (PCOS) is one of the metabolic syndromes that link insulin resistance with diabetes mellitus, hyperandrogenism, and ovulatory dysfunction. PCOS often has a menarcheal age of onset characterized by a failure to establish a regular pattern of menses. In the case presented, the patient has primary amenorrhea assoicated with the development of secondary sexual characteristics, acanthosis nigricans, and acromegaloid attributes. Evaluation of pituitary function revealed that the patient's amenorrhea is secondary to hypergonadotropic hypogonadism, particularly, ovarian insufficiency. This case provides a unique setting to relate the syndrome of insulin-mediated expression of an acromegaloid pnenotype with insulin-mediated pathogenic mecahnisms for ovarian failure to exist concurrently.

Risk factors associated with malignant endometrial lesions in postmenopausal women presenting with abnormal uterine bleeding: a retrospective review

Objectives: To identify clinical, sonographic and hysteroscopic characteristics associated with malignant endometrial lesions. Methods: This is a retrospective descriptive study that included all menopausal women presenting with vaginal bleeding in a tertiary care hospital from January 2007 to June 2010. Clinical, sonographic and hysteroscopic findings were evaluated as predictor variables for development of endometrial adenocarcinoma. Results: Thirteen out of the 215 patients had endometrioid adenocarcinoma, in women presenting with postmenopausal bleeding, with a prevalence rate of 6%. A trend towards harm is seen among the following factors: age of > 60 years (OR 1.19; 95% CI, 0.29-4.46), menarche /- 10mm (OR 2.02; 95% CI, 0.58-7.09), lesion of diameter /- 10mm, hysteroscopic characteristics (lesion diameter of less than 1 em, presence of cystic space and soft consistency) increases the probability of carcinoma.

Intrauterine insemination: A cross-sectional study on determinants of success / Philippine Journal of Obstetrics and Gynecology

Intrauterine insemination (IUI) together with controlled ovarian hyperstimulation (COH) has been increasingly used for the treatment of variety of subfertile indications, both male and female or even combined. The overall success rate of IUI ranges from 4% to 66%. The wide variance of success of the procedure is likely to be influenced by a number of factors. The pregnancy rate in the local setting has never been determined. This cross-sectional study reviewed all available clinical records of patients undergoing fertility work-up who had sperm processing in a hospital-based andrology unit and who underwent intrauterine insemination in either the hospital-based facility or a private clinic from January to December, 2004. Objective: It aimed to determine the pregnancy rate following IUI and assess the intrinsic and extrinsic variables affecting its success and describe the IUI's pregnancy outcome. The intrinsic factors include patient's age (male and female), number of subfertility years, previous reproductive history specifically involving the different factors (male, cervical, uterine, ovarian, tubal, peritoneal). Extrinsic factors include treatment effect and timing of IUI (medicine administered, monitoring of number and size of follicles, endometrial thickness, total motile count inseminated, number of inseminations) and preference for facility (hospital-based clinic or private clinics). Results: For the period of one year, there were a total of 1051 cycles of IUI, 305 in the hospital-based facility and 746 in private clinics. Due to limitation of accessible data, only 424 cycles were studied. However, out of the 424 cycles data retrieved, only 365 showed IUI outcomes. The overall pregnancy rate following IUI was 2.47%. In this study, it seems that only the wives' age (younger) and years of subfertility (2.9 years), were found to be associated with pregnancy rates. The median female age was 35.4 years (range 23.4-48.2), and median male age was 36.5 years (range: 25.0 - 54.4) with a median duration of subfertility of 6.0 years (range: 0.3 -18.0). Conclusion: There is no sufficient evidence to conclude that the other factors studied under treatment, different parameters and topography are associated with rates of pregnancy following IUI.

Successful management of septate uterus in patients with recurrent pregnency loss: A report of two cases

Two women presenting with recurrent pregnancy loss were both diagnosed to have septate uterus. After hysteroscopic resection of the septum under laparoscopic guidance, successful term pregnancy was achieved in one patient, while second patient is currently on her 24th week of gestation. Septate uterus is the most common type of congenital uterine anomaly and has long been known to be associated with recurrent miscarriages, late-term abortion, and preterm labor. The pre-treatment abortion rate is 90%, which is both distressing for the patient and frustrating for the physician. Hysteroscopic septal resection under laparoscopic guidance is considered the standard for treatment, and is shown to improve reproductive outcome.

Intrauterine insemination among Filipino couples with processed total motile count of 1.0 x 106 or less: Semen quality profile and prognosis for pregnancy

Objective: To determine the pregnancy rate after intrauterine insemination using samples with. processed total motile count of 1.0 x 106 and less and describe the semen quality profile of Filipino males with severe male factor infertility in both the raw and processed semen samples. Design: Retrospective descriptive study. Setting: Andrology Laboratory, St. Luke's Medical Center. Patients: 307 infertile Filipino couples who underwent 426 IUI cycles. Main Outcome Measures: Pregnancy rate (PR) after intrauterine insemination. Results: A total of 10 pregnancies were obtained out of 426 IUI cycles, for a pregnancy rate per cycle of 2.4%. Seven of these eventually delivered to term, for a live birth rate of 1.6%. Among those who did not get pregnant with IUI, 8 had spontaneous pregnancies within 1 to 5 year period of follow-up for a spontaneous pregnancy rate of 1.9%. As expected, all the semen parameters analysed showed improvement after semen processing in all subjects. However, these improvements failed to result in a more acceptable pregnancy rate. Among the parameters, morphology was notably better among those who had pregnancies. Conclusion: The chance of pregnancy with IUI using semen samples with processed total motile count of 1.0 x 106 or less is relatively low. For these couples, it may be more prudent to proceed directly to IVF-ICSI than to try several cycles of IUI in futility.

Successful management with artificial reproductive technology and preimplantation genetic diagnosis of a patient with alpha-thalassemia trait and repeated Hemoglobin Bart's Hydrops Fetalis Syndrome

A 38 year-old woman who had history of repeated Hemoglobin Bart's Hydrops Fetalis Syndrome in her first two consecutive pregnancies, was diagnosed as having alpha-thalassemia trait. On further investigation was likewise found to have a-thalassemia trait. Successful term pregnancy wa achieved through in-vitro fertilization with preimplantation diagnosis. Alpha-thelassemia is a common genetic disease that is prevalent in Southeast Asia. A couple with a-thalassemia trait is asymptomatic, but, they have 25 percent chance of having a child with the most fatal type of thalassemia-Hemoglobin Bart's Hydrops Fetalis Syndrome. Preimplantation genetic diagnosis is an established technique that provides an alternative to prenatal diagnosis for patients who are at risk of transmitting serious genetic disorder to their offspring.

Disminución de ácido fólico y alteraciones cognitivas en pacientes con epilepsia tratados con fenitoína o carbamazepina, estudio piloto / Decrease of folic acid and cognitive alterations in patients with epilepsy treated with phenytoin or cartnabazepine, pilot study

Introduction. Phenytoin and carbamazepine were the antiepileptic drugs most frequently used in Mexico and throughout the world. Epileptic patients who take these drugs have a variety of collateral effects including the decrease of Mates plas-matic level. Low serie folie acid concentration has been associated with a decline in cognitive functions. The administration of a combined treatment with folie acid could ameliorate these difficulties. Objective.To describe the effect of the folie acid in the cognitive function in epileptic patients who take phenytoin and carbamazepine. Methods. We chose patient who have epilepsy and that are being treated with phenytoin, carbamazepine or both and formed two groups. The study group was treated with a daily dose of 5 mg of folie acid and the control group was administered placebo for a period of six months, with nine patients in each group of same age, sex, education level, epilepsy's evolution, frequency of seizures, EEG abnormalities and antiepileptic drugs plasma levels. We registered data at the beginning (basal) and at the end of the study. Results.Measurements of basal folie acid plasma levels in both groups were under the referential value. The neuropsychological assessment at the beginning (Mini-Barcelona test) showed a deficit in the verbal memory skills in both groups. After six months of treatment with folie acid (study group), the folie acid plasma level was 12.2 mg/mL (p < 0.01) higher than the basal value. Verbal memory test has improved with respect to the basal value (p < 0.05). The numbers of seizures and the plasma levels of the antiepileptic drugs remained unchanged. On the other hand, the group treated with placebo did not improve. Conclusion.Treatment with folie acid is safe and without side effects, it improved the cognitive function in patients with epilepsy treated with phenytoin and carbamazepine.

Introducción. La difenilhidantoína (DFH) y la carbamazepina (CBZ) son los antiepilépticos más empleados en México y en el mundo, los pacientes con epilepsia que emplean estos fármacos presentan una disminución en las concentraciones séricas de ácido fólico, una de las causas que pueden contribuir a un deterioro cognitivo, por lo que la terapia sustitutiva con ácido fólico pudiera mejorar estas alteraciones. Objetivo. Describir el efecto de la disminución del ácido fólico en la cognición de pacientes con epilepsia tratados con difenilhidantoína y carbamazepina. Material y métodos. Incluimos pacientes tratados con carbamazepina, fenitoína o ambos, con epilepsia. Formamos dos grupos: Un grupo experimental recibió ácido fólico 5 mg/día y otro grupo control recibió placebo durante seis meses, nueve pacientes en cada grupo; pareados en la edad, sexo, escolaridad, tiempo de evolución, námero de crisis, alteraciones EEG, niveles séricos de anticonvulsivos, realizamos estudios neuropsicológicos al inicio (básales) y al final del estudio a ambos grupos. Resultados. Las básales del ácido fólico en ambos grupos estuvieron por debajo del valor de referencias. En las pruebas neuropsicológicas (básales) (prueba de Mini-Barcelona) se halló un déficit en el área de la memoria verbal en ambos grupos. Después de seis meses de tratamiento con ácido fólico (grupo experimental) los niveles de ácido fólico alcanzaron 12.2 ng/mL (p < 0.01) con respecto a su basal; las pruebas de memoria verbal mejoraron con respecto a su basal (p < 0.05); el námero de crisis y los niveles séricos de los anticonvulsivos no se modificaron. El grupo con placebo no presentó ninguna mejoría. Conclusiones. El tratamiento coadyuvante con ácido fólico es seguro, libre de efectos adversos y mejoró las alteraciones cognitivas (memoria verbal) de estos pacientes.

Assessment of nephrolithiasis risk factors among assembly line workers exposed to heat stress

This study involved the assessment of nephrolithiasis risk factors among thirty one (n=31) assembly line workers exposed to heat stress. Assembly line workers working in normal temperature were used as a comparison group. Subjects were matched according to age, body mass index, length of employment and diet. Workplace temperatures were determined using a room thermometer for both groups. Urinary parameters measured include pH, specific gravity, volume, calcium, sodium, phosphorus, uric acid and creatinine. Results showed that the mean levels of urine volume (345.52 +/- 294.88 mL, p0.005483), sodium (121.97 +/- 64.23 mmol/L, p0.006441), calcium (3.39 +/- 2.90 mmol/L, p0.03173), uric acid (3.24 +/- 2.83 mmol/L, p0.046342) and creatinine (11698.93+9091.19 umol/L, p0.035313) were significantly higher in the test group compared to the comparison group. However, there was no significant difference noted in the mean levels of urine pH, specific gravity and phosphorus. The increased risk of nephrolithiasis as assessed in the study was mainly attributed to dehydration during the workshift. Likewise, metabolic acidosis can also provide a possible explanation for the findings