Search

Cardiac valve involvement in antiphospholipid syndrome (APS) has been consistently shown. However, isolated tricuspid valve disease within this syndrome has only been recently reported. We report a patient with primary antiphospholipid syndrome who had isolated tricuspid organic valve disease, pulmonary hypertension and pulmonary thromboembolism. We suggest that the APS should be listed as one of the aetiologies of organic isolated tricuspid valve disease in the adult population. [ABSTRACT FROM AUTHOR]

Background: During pregnancy metabolic disorders that affect differently the fetus, are known. These could be early or late disorders., Objectives: To analyze different biochemical parameters in umbilical cord blood (UCB) of healthy and pathological newborns from mothers with metabolic disorders., Materials and Methods: Samples from UCB (121) were analyzed of newborn from mothers with metabolic disorders who attended at Obstetrics Division. Patients were consecutive, prospective and transversally studied. Newborn were classified as healthy ( n  = 65) and pathological ( n  = 56). The maternal metabolic disorders were gestational or non-gestational diabetes, glucose intolerance, insulin resistance and/or obesity).The disorders of the pathological newborns were intrauterine growth restriction (IUGR) and/or fetal distress. Glucose (Glu), urea, creatinine, uric acid (UA), total bilirubin (TB), total proteins (TP), albumin (Alb), transaminases (ALT/AST), alkaline-phosphatase (ALP), gammaglutamyltranspeptidase (GGT), creatinkinasa (CK), lactatedehydrogenase, amylase (amy), pseudocholinesterase, iron, calcium, phosphorus, magnesium (Mg), sodium, potassium, chlorine, cholesterol (Chol), HDL-Chol, LDL-Chol, triglycerides (TG), high sensitivity C reactive protein (hsCRP) were determined by recommended methods. T-Student's and Mann Withney tests were applied, p  < .05., Results: Pathological neonates ( n : 56) showed a significant decrease in maternal gestation weeks (GW) and in newborn weight (NW) with respect to healthy newborns ( n : 65) from mothers with metabolic disorders ( p  < .0001). Pathological neonates from mothers with metabolic pathologies ( n : 56) showed significant increases in Chol, TG, TB ( p  < .01), LDL-Chol, UA, Mg, hsCRP, ALP levels ( p  < .05) and significant decreases in TP, Alb ( p  < .0001) and Glu, ALT, CK, GGT, amy ( p  < .05) in UCB with respect to healthy newborns., Conclusions: In pathological newborn, the decrease in GW and NW would be related to IUGR that accompany these metabolic disorders. The increases observed of the analyzed parameters would be related to cellular destruction associated to maternal pathology and decreases of the parameters to IUGR with hepatic immaturity.

The etiology leading to neonatal damage is multifactorial, being genital infections one of the causes. The objective of the study was to identify microorganisms of the maternal genital tract that are associated with neonatal damage, in order to prevent future perinatal complications. Seven hundred and eleven pregnant patients attended their prenatal control during the period January 2010-July 2013. Ureaplasma urealyticum and Mycoplasma hominis presence was investigated in umbilical cord blood by metabolic substrates (Micofast-Biomerieux) and that of T.vaginalis, by PCR using specific primers. The microbiological study of the vaginal contents of 288 pregnant patients at weeks 35 to 37 was performed by conventional methods, adding the modified thioglycolate culture for T.vaginalis. GroupB streptococcus (GBS) was investigated in anorectal and vaginal introitus swabs, using selective broth enrichment and subsequent isolation in chromogenic medium. The χ 2 Yates test and Fisher's test were used for independent samples. A p value <0.05 was considered statistically significant. The pathogens significantly related to neonatal damage were M.hominis (p=0.03), T.vaginalis (p=0.03), and BV (p=0.02). Main complications were preterm birth, premature rupture of membranes (PRM), low weight and Apgar score ≤7. U.urealyticum (p=0.35), Candidaspp. (p=0.94) and GBS (p=0.18) were not related to neonatal damage. Since different microorganisms of the maternal genital tract were related to neonatal damage, it is very important to perform the microbiological study of vaginal contents during pregnancy to prevent possible maternal and perinatal complications., (Copyright © 2018 Asociación Argentina de Microbiología. Publicado por Elsevier España, S.L.U. All rights reserved.)

Aims: To adapt to Spanish language the STRATIFY tool for clinical use in the Spanish-speaking World., Method: A multicenter, 2 care settings cross-sectional study cultural adaptation study in acute care hospitals and nursing homes was performed in Andalusia during 2014. The adaptation process was divided into 4 stages: translation, back-translation, equivalence between the 2 back-translations and piloting of the Spanish version, thus obtaining the final version. The validity of appearance, content validity and the time required to complete the scale were taken into account. For analysis, the median, central tendency and dispersion of scores, the interquartile range, and the interquartile deviation for the possible variability in responses it was calculated., Results: Content validity measured by content validity index reached a profit of 1. For the validity aspect the clarity and comprehensibility of the questions were taken into account. Of the 5 questions of the instrument, 2 had a small disagreement solved with the introduction of an explanatory phrase to achieve conceptual equivalence. Median both questions were equal or superior to 5. The average time for completion of the scale was less than 3 minutes., Conclusion: The process of adaptation to Spanish of STRATIFY has led to a semantic version and culturally equivalent to the original for easy filling and understanding for use in the Spanish-speaking world., (Copyright © 2016 Elsevier España, S.L.U. All rights reserved.)

Background: Suturing is the most widely used technique to close leaking sclerotomies after transconjunctival sutureless vitrectomy (TSV). However, with the aim of avoiding the disadvantages caused by conjunctival stitches, there have been described other closure techniques, such as the cauterization of the conjunctiva placed over the incisions. To continue advancing knowledge of the incisional occlusion effect achieved by conjunctival diathermy, it would be also interesting to study the wound closure resistance obtained under intraocular pressure (IOP) changes, given that in the early postoperative period eyes are subjected to pressure stress. In our study, we compare the mechanical resistance observed in sclerotomies treated with bipolar diathermy after TSV compared to that found in incisions in which cauterization was not performed., Methods: This was an experimental, randomized, and observer-masked study in which 23-gauge TSV was performed in 80 cadaveric pig eyes. Once each vitrectomy was finished, cauterization was performed with bipolar diathermy forceps on the conjunctiva placed over one of the superior sclerotomy sites; no maneuver was performed over the other superior incision. IOP was gradually increased by means of the vitrectomy system (Accurus; Alcon Laboratories, TX) until one of the superior sclerotomies opened, allowing internal ocular solution to escape., Results: In 35 % of cases (28 of 80 eyes), sclerotomies subjected to diathermy allowed intraocular fluid escape first (p = 0.01). When comparing opening pressure values, cauterized incisions leaked at significantly higher pressure levels than those in which diathermy was not applied (p < 0.001)., Conclusions: Bipolar diathermy on sutureless sclerotomies has demonstrated to be, in our experimental model, an effective method for increasing the sclerotomy closure resistance. Although its use in vitrectomized eyes has previously been described, our study is the first to analyze the response of cauterized sclerotomies to IOP increases.

Purpose: To assess the influence that hydration applied on the sclerotomy edges may have on incisional closure resistance after transconjunctival sutureless vitrectomy (TSV)., Methods: Experimental, randomized and observer-masked study in which 23-gauge TSV was performed in 80 cadaveric pig eyes. Once each vitrectomy was finished, hydration with balanced salt solution (BSS) was applied on the sclerotomy edges of one of the superior incision sites; no maneuver was performed on the other superior sclerotomy. Intraocular pressure (IOP) was gradually increased by means of the vitrectomy system (Accurus; Alcon Laboratories, TX) until one of the superior sclerotomies opened, allowing internal ocular solution to escape., Results: In 45% of cases (36 of 80 eyes), sclerotomies subjected to hydration allowed intraocular fluid escape (p = 0.43). There were no differences when comparing opening pressure values of hydrated and non-hydrated sclerotomies (p = 0.19)., Conclusions: Scleral hydration did not demonstrate increase in the sclerotomy closure resistance in our experimental model. Given the widespread use of sutureless TSV around the world, the results obtained in our research, in spite of being negative, may contribute to the knowledge of the behavior of sutureless sclerotomies.

Purpose: To evaluate the relationship between the photoreceptor layer status (inner segment ellipsoid band and external limiting membrane) and the foveal avascular zone size, as a result of macular perfusion, in patients with diabetic macular edema., Methods: This observational case series study included 151 eyes of 118 patients with naive diabetic macular edema. The length of the disrupted photoreceptor layer was assessed by optical coherence tomography. The foveal avascular zone diameter was measured on fluorescein angiogram., Results: No significant association was found between the foveal avascular zone size and the mean lengths of the disrupted inner segment ellipsoid band nor the external limiting membrane in patients with naive diabetic macular edema., Conclusion: Macular ischemia, which lengthens the distance from the perifoveal vessels to the center of the fovea and may disrupt the normal flow of nutrients by simple diffusion to the photoreceptor line, does not seem to influence on inner segment ellipsoid band nor external limiting membrane integrity. Future studies may evaluate the effect of choroidal vascularization on the photoreceptor layer status to enhance the knowledge about the photoreceptor layer nutrients source.

Purpose: To evaluate the influence that the origin of incisional vitreous incarceration may have on the presence of postoperative conjunctival blebs over sclerotomies after transconjunctival sutureless vitrectomy (TSV). Blebs are formed by incisional leakage due to incompetent closure., Methods: Twenty-three-gauge TSV was performed in 83 cadaveric pig eyes. Once each vitrectomy was finished, ultrasound biomicroscopy (UBM) was used to assess the presence of postoperative conjunctival blebs over the sclerotomy sites, as well as the existence of vitreous incarcerated in incisions. Vitreous strands may come from the perisclerotomy area, running parallel to the sclera toward the inner hole of the sclerotomies, or may radiate from the core of the vitreous cavity., Results: Vitreous entrapment was found in 73.9% of the sclerotomies; 43.4% of the incisions showed vitreous strands coming parallel to the sclera (12.9% of them showed conjunctival bleb), 19.7% of the wounds presented vitreous aiming toward the core of the vitreous cavity (2% of them had conjunctival bleb) and 10.8% of the entrances presented both vitreous incarceration sources (none of them showed bleb). Incisions with vitreous entrapment parallel to the sclera were associated with a significantly greater sclerotomy leakage rate., Conclusions: Sclerotomies with vitreous incarceration coming from the core of the vitreous cavity showed a greater incisional closure competency than that observed in incisions with vitreous entrapment coming from the pericannular area; if these results were confirmed in humans, different postoperative suture rates may be expected on sclerotomies according to the vitrectomy degree performed in different areas of the vitreous cavity.

Background: The aim of this study was to compare the outcome of 3 months vs. 18 months of amiodarone treatment after atrial fibrillation (AF) conversion in patients who experienced the first episode of persistent AF., Methods: We included 51 patients who experienced the first episode of persistent AF receiving amiodarone (600 mg) daily for 4-6 weeks. If AF persisted, electrical cardioversion (ECV) was performed. All patients received amiodarone (200 mg daily) for 3 months and then were randomized to amiodarone (Group I) or placebo (Group II) and followed for 15 months. The control group comprised 9 untreated patients undergoing ECV. Treatment effectiveness was evaluated using a Bayesian model., Results: Eighteen months after AF reversion, 22 (81.5%) patients in Group I, 13 (54.2%) patients in Group II, and 1 (11.1%) patient in the control group remained in sinus rhythm. No differences were found between Group I patients who required ECV and Group II patients. Sinus rhythm was preserved in all Group I patients when it was achieved during amiodarone administration. Limiting adverse effects occurred in 3 (11.1%) patients in Group I., Conclusions: In patients regaining sinus rhythm after the first episode of persistent AF, a 3-month amiodarone treatment after reversion is a reasonable option for rhythm control.

Hypothyroidism during pregnancy is infrequent, but its presence is associated with maternal and fetal complications. We present the case of a young pregnant woman with no previous history of cardiovascular disease, who consulted for orthopnea, chest pain and edema in both legs. Laboratory tests demonstrated a hypothyroid condition and a nephrotic syndrome with renal failure. The echo-Doppler exam showed a four chamber dilatation with systolic dysfunction. Treatment with intravenous levothyroxine improved her medical condition. We analyze the effects of thyroid hormone on the heart and vascular system and discuss the pathophysiologic mechanisms of heart failure during pregnancy.

A method is described for determining and quantitating organic acids (oxalic, malic, citric, and fumaric) and vitamin C by liquid chromatography with a UV-visible detector that allows simultaneous monitoring at 2 wavelengths. The method was applied to samples of green beans (Phaseolus vulgaris L.). Recoveries were 97.8% for oxalic acid, 98.9% for malic acid, 98.7% for citric acid, 99.2% for fumaric acid, and 98.5% for vitamin C. Method precisions (coefficients of variation) were 1.7% for oxalic acid, 0.8% for malic acid, 0.9% for citric acid, 1.5% for fumaric acid, and 1.2% for vitamin C. Measurement precisions (coefficients of variation) were 1.32% for oxalic acid, 0.33% for malic acid, 0.62% for citric acid, 1.01% for fumaric acid, and 0.39% for vitamin C. Limits of detection were 0.025 mg/mL for oxalic acid, 0.022 mg/mL for malic acid, 0.024 mg/mL for citric acid, 1.0 x 10(-4) mg/mL for fumaric acid, and 2.7 x 10(-4) mg/mL for vitamin C.

The antiarrhythmic effects of amiodarone hydrochloride 200 to 600 mg/daily were studied in 25 patients with ventricular tachycardia (VT). The arrhythmia was registered on a 24 hours two channel Holter recording. This study was performed before and after one month treatment with the drug. The adequate suppression of the VT was observed in 25 patients. The drug showed a total suppression of ventricular ectopic activity in 10 patients (40%) (4 at a dose of 200 mg/daily, 5 at 400 mg/daily and 1 at 600 mg/daily) and a satisfactory reduction (total suppression of couplets and VT and more than 85% reduction of premature ventricular beat frequency) in 12 patients (48%) (6 at a dose of 200 mg/daily, 5 at a dose of 400 mg/daily and 1 at a dose of 600 mg/daily). After a mean follow up of 15.9 months on continuous amiodarone therapy there have been no recurrences of arrhythmia on Holter recordings. No patient died during the study. Side effects were minimal and limited to corneal microdeposits at slit lamp examination without impairment of visual acuity. According to our results amiodarone is an excellent and safe agent for the treatment of complex ventricular arrhythmias.

Sudden death following steroid pulse therapy has been recently reported. Continuous electrocardiographic recording was performed 24 hours before, during, and 24 hours after each one to three high dose intravenous methyl prednisolone pulses administered of five patients with severe ankylosing spondylitis unresponsive to conventional therapy. No increase in supraventricular or ventricular arrhythmias was observed. Bradyarrhythmias, conduction disturbances or ischemic changes were not found. Cardiovascular symptoms did not occur in any case; there were no significative changes in any of the clinical controls. Transient elevations of serum glucose were observed in all patients. Although a transient increase in potassium and decrease in sodium urinary excretion was noted, serum levels remained within normal values.